We recently had a patient who required long term (~ 6 weeks) of IV abx. Hx of IVDU and a known hard stick. An attempt was made to place a PICC in the radiology suite under flouro, but they were unable to advance the catheter over the guidewire. Upon US both extremities, it was noted that there were B/L basilic thrombus. The radiologist terminated the procedure and declined to place another line. Fast forward 5 1/2 weeks and we have thus far placed 6 or 7 midlines for a variety of complications (leaking, patient pulled out, red, etc.). On to the questions:
1. Does anyone have a suggestion as to what may have worked for this patient since a PICC was out and midlines failed so frequently?
2. With the thrombus's B/L, what is the recomendation for placing a midline in these veins? My assumption is that is why the lines placed in these veins failed.