I am often asked by physivians to insert picc lines into severely edematous arms. I refuse but some of the picc nurses do insert them. Is this appropriate?
I think it's important to know the cause of the edema. Patients in septic shock will often be edematous, we also have infants with protein deficiencies that cause generalized edema. I recently placed a PICC in a patient with subq emphysema from neck to arms that caused signifcicant edema. I weigh risk versus benefit and usually place the PICC if it's warranted.
We evaluate each patient for appropriateness for line placement, and often end up placing in patients who have edema. If only one arm is swollen we ask for a doppler first.
I totally agree with the other comments. You can not make a blanket rule that all edematous extremities can not have a PICC. You must evaluate the cause of the edema. Certainly if you suspect the edema is caused by an obstruction to venous return from thrombosis or some other type of occlusion problem, a PICC is not indicated. But there are many causes of edema that would not prohibit a PICC. 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