The parent of an 8 year-old female with chronic parenteral nutrition dependence secondary to chronic intestinal pseudo-obstruction calls with leaking at right upper extremity peripherally inserted central catheter(PICC) within 2 hours of nightly infusion. What is the first thing to recommend to family?
The correct answer is b. Clamp PICC proximal fracture and refer to emergency department. If a Broviac or PICC is fractured, it should be clamped proximally to the fracture to prevent bleeding and contamination. Sometimes the PICC can be re-wired. But the patient should come to the emergency room immediately to address this central line emergency. PICC repair kits are not available in the same way as Broviac repair kits. Although having a visiting nurse pull out the PICC will address the patient’s catheter problem, it won’t provide her with a means to receive ongoing home parenteral nutrition. Some institutions recommend testing and/or treating for possible bacteremia in the setting of central line fractures given the associated risk. While checking blood cultures and starting IV antibiotics may be some actions to consider, they are not your first priority.