I placed a 4 fr single lumen SOLO in the R brachial vein on Friday--pt had no other veins. 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). 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? Any similar experiences/advice? Also, in regards to measuring arm circ (if it was done correctly), what instructions do you give the bedside RN? How much increase in arm circ do you ask the RNs to call...what do you do with the info?  We don't have covg on Sat or Sun, what should you ask the MD to do with the info?
Any help would be appreciated. Thanks
Doesn't sound like this patient had much left to access and you did the best you could do with what you had. If in the same situation I would've probably done the same as you.
Kevin
Kathy Kokotis
Bard Access Systems
Tunneled small bore central catheter via the jugular should be done. There is one published article on their use in JVIR which is SIR's journal. Slyvia PYC on clinical hotline can give you reference. 800-443-5505
Manufacturers who have such a device are Angio, Bard and Medcomp. I don't think I missed anyone. These are 6 french single or dual lumen devices.
Kathy
Kathy Kokotis
Bard Access Systems