Double lumen picc placed in left upper arm brachial vein without difficulty on 3/15- tip at CA junction(pt. getting TPN,lipids,PCA, and IVF). On 3/21 left elbow became swollen,warm, red. US done- shows large volume clot in lower left jugular vein. No clot extends around the picc. Subclavian,axillary,brachial patent with good flow. MD's discontinued picc line on 3/21. Left elbow symptoms more severe, diagnosed as cellulitis and started on abx. Was all of this caused by the picc line? Thanks.
Possibly but hard to see with the info given. Brachial veins are smaller diameter than basilic or cephalic. It is strange that there was good flow ( assuming that means not extensio of the thrombus) in the axillary or brachial. Cellulitis and thrombosis are quite different diagnoses. Are you certain there had not been any previous CVAD or attempts in the IJ or subclavian veins? Why was brachial chosen? Smallest and veins with most risk for damage to nerve, etc. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks Lynn- The pt. was diagnosed 3/10 with stage IV Lg B Cell lymphoma, received 5 cycles of RCHOP all through pivs, also had some IT chemo. The veins in his arms are so sclerosed(?) they look and feel like hard tendons. I used the brachial vein as that was the best vein I could find using us. He did have a BM tx 11/10 - maybe he had an IJ then- I asked him if he ever had a line in his neck or chest and he said "maybe, I don't know". They have started him on Levonox 40mg sq q day for the thrombus. It is possible that this IJ thrombus could be IJ sclerosis? Should I request a different radiologist to read the US? I would hate for him to be on Levonox if it truly isn't a thrombus. Please advise and thanks in advance!!
Lots of risk factors for thrombus!! No one can or should make a diagnosis just from a few notes on this forum. Whether you should ask for a 2nd opinion is a decision based on the political situation in your hospital and your degree of empowerment to be a patient advocate. So I can't answer that question for you. He could have had a previous catheter with some thrombosis that lead to permenant stenosis. I don't think it would be confused with sclerosis though. Have you discussed this with the primary care physician? Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861