This is the report. The background on this patient is he is an active IV heroin drug user. He needs long term IV antibiotics for 'discitis of the lumbar region'. Every PIV that has been placed does not last longer than 24 hours. We've avoided the left arm because of this report:
Study Result: 9/4/2017
Left upper extremity venous ultrasound
INDICATION: Left arm pain
FINDINGS: Doppler ultrasound of the Left upper extremity shows normal flow in
the subclavian, axillary, and basilic veins. There is thrombosis of the left
cephalic vein.
IMPRESSION
IMPRESSION: The left cephalic vein is thrombosed. The vessels in the upper arm
are patent.
Previous doppler study on right arm: 8/28/2017
Study Result
Examination: Grayscale and color doppler ultrasound of the upper extremities.
History: Pain and swelling in the arms since IV placement.
Comparison: None.
Findings: There is thrombus within a small branch off of the right cephalic
vein. The right and left internal jugular, innominate, subclavian, axillary,
basilic, cephalic, brachial, radial, and ulnar veins demonstrate normal
compressibility and color-flow.
IMPRESSION
Impression: Thrombus within a small branch off of the right cephalic vein. No
evidence of right or left upper extremity deep venous thrombosis.
Is it safe to place a PICC or Midline catheter in either the basilic or brachial veins of either arm? The physician caring for him knows there is a huge risk that the patient may use any line we place for IV Heroin (he has ordered the patient to have a 24/7 sitter). In fact, that is what we think he has been doing with his PIV's. "Contraband" has been found in his room after a needle was found in his bed, a pill in his night stand, etc.
Thanks for any information!
Suzanne
2 separate issues here. You did not state what the infusion therapy is and how long it is expected to be needed. So I can't determine PICC vs midline. RE thrombosis, you could easily access the basilic with the smallest size catheter and ensure correct tip location in SVC to minimize thrombus risk. RE VAD use for street drugs, his drug use needs to be addressed by those professionals. If he were on some other oral medication to substitute would he still inject the heroin? Not sure about treatment for drug addiction but that might be a part of the answer. If he is unwilling to try treatment, plus the 24/7 sitter, not sure what you can actually do. But you can't deny treatment for his infection. The only other option is to work with infectious disease to see if an oral ABX would work for him. No good options here. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861