Case #1: PICC requested for long-term abx. Pt has symptomatic non-occlusive DVT right brachial and right IJ, and VP shunt left IJ. Attempted PICC insertion on LUE and met resistance at juncture of VP shunt. Aborted insertion and deferred to IR. IR placed small bore tunneled PICC right EJ.
Case #2: PICC requested for TPN. Pt has midline right brachial, right subclavian CVC terminating mid-SVC, and occlusive DVT right IJ. Midline was placed 12/26. DVT dx on 1/6 after failed right IJ cvc placement. right subclavian placed same day. Pt has AAA 9.1cm with dissection. Vascular doesn't want LUE attempt for PICC, want RUE. Called IR for guidance and was told RUE was still ok with occlusive DVT in right IJ. Despite ok from IR we deferred placement for them.
What are thoughts on placing ipsolateral lines with documented DVT?