53 y/o male, severely malnutritious, hypoalbuminemic. Hx of Protein C and Protein S Deficiency, CVA, Crohn's Disease, seizure, anemia.
Because of Crohn's disease, he had multiple surgeries for bowel resections. The only way to give him nutrition is intravenous one.
Numerous PICC's, Central lines, Port-a-caths had been placed over the last 10 years. They were removed either because of DVT or infection. The last problem he had was SVC syndrome. He had multiple septic episodes from femoral central lines. Now it is impossible to have another central line in the upper body parts.
What should we do?
1) Translumbar Port?
2) PICC via GSV?
I need more coffee!!! This patient is giving me a headache!!!