PICC and central IV lines provide for long-term venous access and tremendous benefits to patients. They are beneficial because with proper administration, they are a low risk for infection and decrease skin puncture wounds for blood sampling, especially for patients with long-term care needs. PICC and central IV lines also provide prolonged venous access and a means for administrating medications that would otherwise be irritating to smaller peripheral blood vessels. Like all medical procedures, PICC and central IV lines also present risks of serious injury if they are not properly inserted, managed and removed.
Central lines are commonly inserted in hospitals and widely used for IV access in medical practices across the country, particularly for chemotherapy patients. While their benefits are well-known, adequate training, preparation and technique are essential to prevent serious injury to patients in the insertion, management and removal of PICC and central IV lines.
PICC and Central IV Line Infiltration Injury
As with all IVs, central and PICC lines are designed to provide venous access so medications can be administered when necessary. Therefore, medical staff must assess the site at appropriate time intervals to make sure the IV line remains in the vein and is infusing properly. If the line backs out of the vein or stops, clots off or stops functioning properly, IV infiltration can occur and the infusing medication can absorb into the tissues instead of the blood. IV infiltration and extravasation injuries can result in serious burns, scarring, nerve damage and long term disability. It can also prolong hospital stays and increase medical expenses.
PICC Line Mistakes and Injury
A PICC line is a peripherally inserted central catheter that starts in the vein of the arm above the elbow and goes into the center of the chest to the superior vena cava. A PICC line has many advantages in that it can be used for a long period of time to administer medication directly into the larger vessels of the body. PICC lines can also be placed in the jugular vein, something which is becoming more and more popular.
The importance of placing the PICC line in the proper vessel cannot be overstated, especially if it is being placed in the jugular vein. Other structures are located in and around the jugular vein including the carotid artery. If a PICC line or other central line is inadvertently inserted into the carotid artery instead of the jugular vein and fluids are infused, they will likely travel to the patient’s brain and result in serious injury, brain damage or, more likely, death.
- Misplacement of PICC lines: While a PICC line is being inserted, it can migrate from the proper position if the practitioner is not careful. After the insertion of the catheter, the position of the tip should always be confirmed by x-ray to make sure it is placed in the proper vessel. Confirmation of the tip placement is essential before the PICC line is used. Securing the PICC catheter is also essential to help prevent dislodgement or other migration.
- Air embolism: Proper precautions must be taken to ensure that air is not allowed to enter the blood vessel during insertion, maintenance or removal of a PICC or Central IV line. Removal of a PICC line inserted through the jugular vein is particularly dangerous and can result in air embolism if proper measures are not taken to prevent the entry of air. This includes applying an air occlusive dressing once the line is removed.
- Nerve injury: Large sensitive nerves run in and around the jugular vein as well. During insertion of a jugular PICC line, the nearby nerves can be injured if proper procedures are not followed.
- Catheter breakage: Some catheters are very long. If proper measures are not taken, a catheter can break during insertion or removal. This commonly occurs if excess pressure is applied during the process. For this reason, catheters should be measured upon insertion and removal to make sure none of the catheter has broken off and remains in the body. This ensures that prompt action can be taken to remove the broken catheter before it migrates to vital organs and causes serious injury.
- Injury from IV removal: PICC lines should never be forcefully removed as they can cause severe damage to the venous system. If the line is difficult to remove, warm compresses should be applied to dilate the vein, especially in the case of a venospasm. The application of warm compresses and allowing the patient time to calm down should allow the vein to relax such that the PICC line can be removed. Forceful removal of a PICC line can result in tragic consequences including rupture of the vein or catheter.
If you suspect medical negligence, do not hesitate to contact Burnside Law Firm LLP at our Augusta, Georgia, law office. Our lawyers offer experienced, strategic advocacy in cases involving IV infiltration and IV injury. Call (706) 432-8320 or contact us by e-mail for an initial consultation.