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practice questions re renal patients, SVC graft and pacers

Hi All

I am hoping for some feedback and wondering if there are industry standards involving my questions.

We were asked to place a PICC in a patient who had an SVC graft and noted cavoatrial stenosis at the time of surgery which had been almost a year ago. Should there be some type of vascular study done before attempting a PICC?

Our current policy is to check with nephrology for a patient that has a GFR

Is it up to the cardiologist to clear a PICC for someone with a new pacer/ICD? I have read that there are not any documented cases of a PICC dislodging a wire but wondering how others deal with this situation.


 On a patient with any type

 On a patient with any type of obstruction or stenosis in the SVC, there is a great chance that any CVC would not be properly advanced to the CAJ. If you know this before the procedure, it should definitely be taken into consideration. If attempted, what will you do if the cath will not advance completely? This decision should be based on many factors - length and type of therapy needed, exact pathophysiology causing the obstruction, etc. I am not aware of any standards about this situation. 

I am concerned about your 48 hr policy for IJ catheters. This seems extrreme to me and one I have never seen. I know this is not based on any standards, guidelines, or recommendations. I would agree that the dressing is difficult to maintain intact on an IJ line but this is the best insertion site for renal patients. Check the DOQI Guidelines for renal failure patients and vascular access. 

Usually a PICC or other CVC is not placed until a pacemaker is about 6 months old. Insertion is not going to cause damage to the pacer. Removal can fracture a lead if there is thrombosis bridging between the lead wire and catheter. We have an online CE course on this issue of pacemakers and CVCs. Cllick here to see the full course description. The-Ins-and-Outs-of-Impanted-Pacemakers-and-CVC-s. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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