Everyone can think of many examples of complications associated with vascular access devices and infusion therapy. Textbooks and all types of journal publications provide much information about the signs and symptoms, prevention, and management of these events - always with the goal of prevention.
What about those adverse events that are not found in the published literature? Do they actually happen? If a study or case report about a specific complication can not be found in the published literature should we dismiss the idea that it could happen?
A primary example is venous air embolism (VAE) following the removal of a PICC. The catheter is slowly withdrawn from the vein and pressure is applied to stop any bleeding. Do we need to use the same precautions to prevent VAE with a PICC removal as we use with a subclavian or jugular insertion site? After searching extensively through the published literature in the English language, there are no publications that have documented VAE with PICC removal. There are a few reports of VAE with PICCs occurring due to attaching an unprimed administration set but none occurring during PICC removal.
Based on anatomy and physiology, we know that a skin-to-vein tract can develop especially with lengthy catheter dwell times. Also, a fibrin sheath frequently covers the entire length of catheter and could remain intact inside the vein when the catheter is removed. The 2016 Infusion Therapy Standards of Practice includes this information and advises to use methods to prevent VAE for all central vascular access devices (CVAD).
In my opinion, we must use our knowledge of vascular anatomy and the physiology of blood flow, merged with our critical thinking skills based on patient assessment. Armed with this information, our professional responsibility is to apply the safest methods possible to prevent such events. Additionally, if an unreported event occurs in your facility, please share your experience by publishing your case report. No publications on a complication, yet anatomical and physiological evidence supports the possibility indicates the need to apply the usual precautions in this example. What is your opinion?
Author: Lynn Hadaway
Lynn Hadaway has more than 35 years experience in infusion nursing and adult education. Her experience comes from multiple acute care settings, healthcare manufacturing, continuing professional education.