I placed a 4 fr single lumen SOLO in the R brachial vein on Friday--pt had no other veins.Â She is awaiting liver transplant and 3rd spacing everywhere, she's on coumadin (INR 2.7) for a-fib, the coumadin caused a small subdural hematoma, the altered LOC from the SDH caused her to aspirate and she now has pneumonia....shall I go on?
Anyhoo...Her arm grew over the weekend due the the third spacing (don't get me started with the measurement thing), and I was worried about a possible DVT (despite the coumadin).Â U/S showed no DVT, but the edema was severe enough to compress the vein and allow zero blood flow around the PICC line.Â
I d/c'd the PICC, and luckily was able to start another one in the other side, much higher in the extremity.Â
What do you all think?Â Any similar experiences/advice?Â Also, in regards to measuring arm circ (if it was done correctly), what instructions do you give the bedside RN?Â How much increase inÂ arm circ do you ask the RNs to call...what do you do with the info?Â Â We don't have covg on Sat or Sun, what should you ask the MD to doÂ with the info?
Any help would be appreciated. Thanks