I am having a disagreement with our ONC CNS about the safe use of PICC for Chemotherapy.
She insists that if there is no blood return, chemo should not be given no matter what.
I say if CXR positively confirms tip placement it is absolutlely safe to give chemo even if there is no blood return, and the reason why the PICC is not giving blood return should be investigated and treated.
We had a Chemo patient with a three months old PICC admittedÂ Friday eveningÂ (PICC TEAM is off on the weekend) there was no blood return, I called from home, told them the do a CXR which confirmed PICC tip is still at Cavo-Atrial juction, so I told them to go ahead use the PICC for chemo and I will deal with the partial withdraw occlusion when I return on Monday. (which I succesfuly did with one dose of Cathflo).
The CNS was besides herself on Monday that I allowed this.
My point to her was, you could get blood return even if the tip is malpostioned in Contra-Lateral Subclavia or Brachio-Cephalic, in IJ or even in Azygus and that blood return only confirms thatÂ the tipÂ is inÂ a VEIN, it does not mean it is always safe, or that the tip is in the SVC. (I have seen good blood return from malpostioned tip)
Am I missing something? shouldn't the critiria be tip in SVC? If it's documented that tip is in SVC is it not safe enought to give Chemo?