SCENARIO--A PICC has been ordered for a patient. Patient is assessed and found with bilateral upper arm burn scars/skin grafting, which also extends well to the axillae. Patient also with limited range of motion and mobility BUE due to scarring/grafting. For the heck of it, also assessed very limited areas of bilateral upper arms NOT affected by burns and grafting with ultrasound and veins found were inadequate in size for 4 French PICC. Veins were then assessed more proximal into the burned/grafted area and were found to be very large, but I would have to place PICC into the scarred/grafted area. Discussed with ordering service, I recommended a Power Line (tunneld/cuffed catheter) as patient needs 6 week course of IV antibiotics.
QUESTION--Would it have been appropriate to go ahead and place the PICC into the scarred/grafted area??? I do not believe so and did not place a PICC. Just wondering what everyone else may have done!!! Thanks.