Question? We have a small outpatient infusion center and we place picc's with sonogram/sherlock system. We have no radiologist or fluroscope on premesis. We had a patient who has a dialysis cath in the right upper chest with tip in lower SVC. I was hesitant to place as we have no access to fluroscopy. We sent him to a local hospital to have it placed. Can the Picc tip still terminate at the CAJ without conflicting with the dialysis cath ? We have CXR on campus and the films are read at the local hospital via computer communication. What is the risk with a picc and another cath in the same place? Especially with a patient who is not critical. Thank you for input.
Of course the bigger issue is have you been cleared to place a PICC by nephrology in this pt? KDOQI guidelines say a small bore jugular line should be placed. If your patients dialysis catheter is a long term catheter it should be in the upper right atrium, if it is a temporary dialysis catheter is should be in CA junction. All that being said if a PICC is the right choice then you should not have a problem. If the PICC has been placed in a potential fistula arm research shows average lifespan is reduced 5 years.
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
It is a temporary dialysis catheter with the tip in the CAJ. I am aware of the restrictions for vein preservation thanks to the INS conferences. Is there any concern that the picc line can get tangled with the other catheter? This pt is a young teen.
Hello,
The catheters are unlikely to "tangle", but you could meet resistance to advancement of PICC due to the presence of the HD catheter...and if successful, have "steal" from the HD catheter during dialysis.
There is lso additional risk of infection/contamination if one gets infected and they are in contact on the inside.
Keely
Keely Ralston RN-BC, VA-BC, CPUI, RCIS
Hello,
The catheters are unlikely to "tangle", but you could meet resistance to advancement of PICC due to the presence of the HD catheter...and if successful, have "steal" from the HD catheter during dialysis.
There is lso additional risk of infection/contamination if one gets infected and they are in contact on the inside.
Keely
Keely Ralston RN-BC, VA-BC, CPUI, RCIS
Thanks again for the info. That is very interesting. I have never worked ICU other than floating years ago, and don't have much experience with dialysis. It seems I was smart to send this pt to a hospital for placement. I really appreciate the help and info given on this forum!
I am really surprised that a PICC was allowed in a young teen who is already on dialysis! Fistula First would be especially important for this patient, perhaps the pt. only has a need for short term dialysis? I am curious...you said you are aware of the KDOQI guidelines, was the MD who ordered the PICC also aware!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
They expect the pt to be off diaysis soon, he has the picc for abelcet. This is a very complicated case. He is just 20yrs.