I attempted to place a PICC in woman who had a right mastectomy with axillary dissection (and subsequent right arm edema); tried left basilic, cephalic veins and could not advance either beyond about 35 cm. After nearly an hour of working with this woman, I arranged with one of the radiologists to get her to the angio suite, with PICC (wire still in place) and sheath in cephalic vein, to see if he could finish the insertion. He tried for nearly an hour, again both cephalic and basilic veins, concluding with an angiogram that she had an occlusion at the right brachiocephalic vein. 3 years ago, she had had an inplanted central access device--unclear about the specifics, but she recalls that the first one "did not work at all" and the second one developed a clot, was removed. On xray, at the time of insertion of what I believe to be the first IVAD, the tip of the catheter is in the area of the mid superior vena cava. Two days later, the xray shows the tip in the area of the junction of the SVC-right brachiocephalic vein. My question--and pardon the lengthy intro--is, of course, regarding her options. She has metastatic disease, and was scheduled to start 5 weeks of chemo. Her peripheral options are close to nil. Would anyone consider a right internal jugular vein PICC for that length of time?Â
Â I greatly appreciate, in advance, your contributions to this forum generally, and my question specifically.
Sally Walker, RN, CRNI
(and relatively new PICC nurse)Â