53 y/o male, severely malnutritious, hypoalbuminemic. Hx of Protein C and Protein S Deficiency, CVA, Crohn's Disease, seizure, anemia.
Because of Crohn's disease, he had multiple surgeries for bowel resections. The only way to give him nutrition is intravenous one.
Numerous PICC's, Central lines, Port-a-caths had been placed over the last 10 years. They were removed either because of DVT or infection. The last problem he had was SVC syndrome. He had multiple septic episodes from femoral central lines. Now it is impossible to have another central line in the upper body parts.
What should we do?
1) Translumbar Port?
2) PICC via GSV?
I need more coffee!!! This patient is giving me a headache!!!
I have serious concerns about placing a PICC via the great saphenous vein in adults. To me, this is just asking for issues with DVTs and this creates a huge risk for your patients. I would advise a catheter placed via the translumbar or transhepatic vein in these cases. There is no published evidence to my knowledge about PICCs in the legs of adults, so you are opening yourself for much liability here.
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
Journal of Medical Imaging and Radiation Oncology. Volume 52, Issue 1, Pages 68-71. Saphenous vein PICC: Technique, indications and safety issues.
We did talk about a translumbar or transhepatic access but the risk of lower body central venous stenosis is high. Patient and family wanted a PICC via saphenous instead. Pt had a serious septic episode with a port from the left subclavian vein.
In some patients, there are no good choices. Just a warning that saphenous vein use for PICC insertion is not recommended unless you have ruled out all other possibilities.
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