A patient with a S/P total hip infection( MRSA) Hx. of DM. AICD in lft chest. Hx. of bil. radical mastectomy.( + CA.with node disection) Rt. breast 2000. Lft breast 2003. Would a PICC be appropriate in the RT. arm? A surgeon said " Mastectomy is not an issue these days".What would INS say about that? Pt to be on IV Abx. for at least 6weeks. Would a groshong tunneled catheter in the rt. chest be a better idea? A mediport?  Help!!
The INS standards of practice call for a physician's order when using an extremity s/p mastectomy. The issue is lymph node dissection and the risk of lymphedema. This must be addressed in your hospital policy and procedures.
For this patient I would prefer a tunneled catheter, preferably inserted by a skilled interventional radiologist with the venipuncture into the IJ. An implanted port would not be my first choice because of the need to change the needle, issues with maintaining the port access needle, etc. Lynn
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
Thanks Lynn. That's what I suggested but thats not what I had to do. The Md's insisted on a PICC in the Rt. arm and it was 3 against 1. I hate when I have to do what I know isn't right.
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
Nadine Nakazawa, RN, BS, VA-BC
half a dozen of one a dozen of another
It is a multi-disciplinary clinical decision and the Medical Physician felt the risk of thrombisis was lower than the risk of an implanted/ tunneled line. I woudl chart that you reveiwed the clinical factors with the physician team and that a PICC line was the vascular access device selected.
The highest risk of symptomatic thrombosis in an oncology patient if Grove is right on that one ( I think they are on the chemo drugs and history of chemo) is 10%. As far as non-symptomatic no one knows what the true result of any location is.
Kathy Kokotis
Bard Access Systems
I agree with Lynn 100% here. I cannot understand why a nurse feels as though he/she "has to do" what a physician orders just because he/she is the physician. Did this physician have sound rational as to why he did not want to place a tunneled catheter? Did you ask him/her for documentation to back up that decision? Was the patient given a good explanation of all of her options? Because the documentation sure is there to give a good argument NOT to place that PICC. It is great to document when there is a need to cover yourself, but what about the patient? Sure sounds like this patient has enough to deal with in life without the added addition of lymphadema, UE DVT, or blood stream infection. Nadines suggestion was perfect. Stand up for your patient. It is not 3 against one. It is three against two.