I have a patient who has a thrombus in both Left & Right upper arm cephalic veins. Thrombus extends from about the AC to top of the arm. I was request to place PIV. I placed a PIV in right forearm quite easily, not sure if vein was cephalic. Good vein easily collapsible. After placement I was told that prior PIV have been placed via ultrasound "above" the thrombus. As it would be safer.
Pt currently as PIV in foot. Should I attempt to place PIV in upper arm? Is PIV in forearm contraindicted?
Debra Rivie RN VA-BC
Long Beach Memorial Medical Center
Long Beach, CA
First, to place a PIV in the arm with a known thrombosis is not below the standard of care, however the standard is for you to know the vein being used and to use a vein other than the cephalic vein or a vein that connects with the cephalic vein. You did not state if you used US but it sounds like the other PIV was placed using US. There should not have been a catheter for fluid/med delivery thru the cephalic veins of either arm since there is known thrombus present. What vein was used for the other PIV? PIV in the foot of an adult probably carries greater risk than using a PIV in the basilic of the forearm. 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