SCENARIO--A PICC has been ordered for a patient. Patient is assessed and found with bilateral upper arm burn scars/skin grafting, which also extends well to the axillae. Patient also with limited range of motion and mobility BUE due to scarring/grafting. For the heck of it, also assessed very limited areas of bilateral upper arms NOT affected by burns and grafting with ultrasound and veins found were inadequate in size for 4 French PICC. Veins were then assessed more proximal into the burned/grafted area and were found to be very large, but I would have to place PICC into the scarred/grafted area. Discussed with ordering service, I recommended a Power Line (tunneld/cuffed catheter) as patient needs 6 week course of IV antibiotics.
QUESTION--Would it have been appropriate to go ahead and place the PICC into the scarred/grafted area??? I do not believe so and did not place a PICC. Just wondering what everyone else may have done!!! Thanks.
I would have made the same assessment and nursing judgment as you did. I would not want to insert through the scarred/grafted area and think a tunneled cuffed VAD is the most appropriate for this patient. 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
As always, thanks for your input Lynn :)
Jeannette Andrews, RN, CRNI, VA-BC
Out of curiosity, is this an acute burn or one that has healed? was it a donor site or a burn injury site? just wondering
Hi Jill-it was healed, not acute with some grafting and some scarring.
Jeannette Andrews, RN, CRNI, VA-BC
Thanks. Your question got my thinker in gear, how much function does that skin have? can it repair? that kind of thing. Definitely I wouldn't place a PICC in scar tissue but if options are limited and on burn patients they sure can be, is virgin skin a requirement for placement? and talking skin, what about tatoos? Do you stick through tatoos? Some of these people are coming in with so many now. I saw a woman with a PICC placed through her psoriasis and very deleterious result. Maybe we need to talk more about skin. I appreciate your question so thanks!