We have recently had a request by a hem/onc MD to  place a PICC on a pt. with a known history of SVC syndrome who is still undergoing radiation/chemo. We declined and referred the pt. to IR and this MD was upset that we just "turfed" the pt. to IR and what guidelines are we using that state we should not be placing PICC's in these pts. Anyone have any evidence based literature, etc that we can use to "educate" this hem/onc MD ? We have been unable to find any written information on the contraindications associated with SVC syndrome and the placement of VADs.. any help would be greatly appreciated
From Bard's instructions for use for Picc line :Poly per-Q-cath, contraindications:The device is contraindicated whenever:
. Previous episodes of venous thrombosis or vascular surgical procedures at the prospective placement site