We have a 79 yr old patient who has endocarditis, recent hip replacement, on hospice at home for end stage cardiac disease (refuses valve replacement). She has had a right mastectomy with node removal. She requires 6 weeks of IV Rocephin. IR placed a left picc, which they were unable to thread to the SVC because of occlusion to the inominate. They left it in place. The nurses were unable to obtain a blood return-she was sent back to IR-they "opened" the PICC up yesterday. According to the IR note the subclavian and the inominate are now occluded-but this is still "an adequate central line" according to the radiologist. Her left arm is swollen today (was not yesterday), and the nurses cannot get a blood return.
Obviously this line needs to be removed. What options do we have for 6 weeks of IV abx? Hickman? Or a right PICC?