We have a 79 yr old patient who has endocarditis, recent hip replacement, on hospice at home for end stage cardiac disease (refuses valve replacement). She has had a right mastectomy with node removal. She requires 6 weeks of IV Rocephin. IR placed a left picc, which they were unable to thread to the SVC because of occlusion to the inominate. They left it in place. The nurses were unable to obtain a blood return-she was sent back to IR-they "opened" the PICC up yesterday. According to the IR note the subclavian and the inominate are now occluded-but this is still "an adequate central line" according to the radiologist. Her left arm is swollen today (was not yesterday), and the nurses cannot get a blood return.
Obviously this line needs to be removed. What options do we have for 6 weeks of IV abx? Hickman? Or a right PICC?
Sounds like a right PICC is all that is left. Has the extremity ever had edema? In my previous practice, my team used mastectomy sides several times successfully. THe first one was the chairman of anesthesiology's wife and it was upon his suggestion.
I also like the idea of a permentent line in the right. The physician may not want to do that thought, because of the diagnosis of endocarditis (bacteremia). I have had endocarditis patients out of no where develop a raging bacteremia during their treatment. Good luck!
Cheryl Kelley RN BSN, VA-BC
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
I think this patient described above is a candidate for a mediport with access in the Right Mid Bicep Basilic vein. I am hypothesizing that this would reduce venous infection due to lymph node removal somewhat, as long as the accessing technique is STRICT sterile and well protected. If I understand correctly, this patient will have ongoing needs for IV therapy till end of life.
Ken Thomas, RN
Institute of Nursing Excellence, Inc.
Kathy Kokotis
Bard Access Systems
What are her jugulars like
Look at a SBCC line in the jugular- Ask IR if they say the article and poster on small bore central catheters in JVIR or at SIR?
Kathy Kokotis
Bard Access Systems