Inserted a PICC in an adult Downs Syndrome pt and after insertion at bedside, CXR obtained for placement confirmation, we realize pt has double SVC. The PICC was inserted in L arm and the PICC is sitting in the coronary sinus via that L SVC. The radiologist confirmed, by reviewing previous CTs of p'st, that se did have Double SVC.
Do you leave the PICC there???? Â Â
That is a decision that should be made collaboratively with the patient's physician after considering the blood flow volume and direction, along with the type and length of therapy required. I wrote about this in a Catheter Connection column a few years ago and you can find that article at http://www.hadawayassociates.com/article13.htm
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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 would never leave a PICC in the position of the persistent left SVC, due to the risks associated with the lack of vigorous blood flow there compared to the SVC and the impact of infusing meds into the coronary sinus.
Honestly, we saw a lot of LSVC's a few years ago and worried about "what was in the water here". We have great xray pictures of LSVCs in our area (weird that we don't see this as often). The ones that we have seen created so much risk for thrombosis based on the plans for therapy. The blood flow and hemodilution isn't in the persistent left SVC, comparable to the SVC. It is a rarity that the hemodilution is adequate with a left SVC. Our radiologists support this. If we had a PICC from the left that ended up in with a LSCV, we started over and inserted from the right side.
dtarvin, RN What are the planned treatment drugs/infusions for this patient? Do the radiologists support this treatment in the LSVC?
Gwen Irwin
Austin, Texas
Moving to the right side could be an alternative in some patients. But some patients will not have a right sided SVC. Some will have both a right and left sided SVC. That is why I said it should be a collaborative decision with all the facts for each patient. There could be times when you may be faced with only the choice of a left SVC.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Jeffery Fizer RN, BSN
Definitely don't leave it in the coronary sinus. As far as R SVC - it may be non-existant, or much smaller than the L SVC which would be typical for these patients. You can leave a PICC in the LSVC if radiology has examined (IR with flouroscopy if possible), and it's not in the coronary sinus.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center