Pt. on our unit is a 25 yr. old female dialysis pt. She has a thrombus in her IJ, cephalic, and basilic vein of (r) arm. Has fistula in her (L) arm with left hemodialysis cath present. She had a PICC in the right arm 2 weeks ago. Right arm has 4+ edema. Our staff asked for a femoral line to be placed. Instead Dr. wrote for peripheral I.V. to be placed for fluids and her pain meds. She was to have a CT the next day.
They were able to place peripheral #20 angio in right arm, despite the major swelling. We felt this was unsafe due to her clots in that arm and the fact you would not be able to tell if line was ever infiltrated...would also sometimes get I.V. Phenergan. Dr. said because Heparin was infusing through the I.V. it was not a problem. Labs had to be drawn either in dialysis or from her foot. Please help shed some light on this problem...Should peripheral line be placed in arm with major swelling and clots in those veins identified above????
Thanks in advance for your help
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
An unfortunate situation for patient and staff,but it got me wondering---are the veins of the dorsum of the left hand OK to use in this sort of situation? I know about the NKF recommendations for vein preservation in anticipation of a fistula or graft but what about afterwards?