My thought process here (and it is mine as I coudln't find much about hthis practice) is that if the blood flow in the extremity is already compromised, then placing a PICC may expose the patient to negative consequences IF the second vessel becomes compromised. Now with that said, if the cephalic is thrombosed, and you are placing the PICC in the basilic or brachial, then it may not be a significant as if the thrombus was in the basilic and you are placing in the brachial.
Secondly, a thrombosis is a vein in the extremity is one thing, but how to you know that it is NOT in the axillary or subclaviian? As they say, all roads lead to home (SVC) but the road one must travel is thru the axillary and subcalvian.
Hope this helps!
Cheryl Kelley RN BSN, VA-BC
I agree with Cheryl. You must make a detailed assessment of the patient and will hopefully have another extremity to use. Placing a second catheter in an extremity already compromised by a thrombus in any vessel is not a good idea.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway, M.Ed., NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Bard Access Systems
I bet 70% of all catheters regardless of the type have undiagnosed thrombosis. The acute care CVC's are so deep the symptoms do not show until complete obstruction of the pathway. If we scan all patients pre and post placement I think that medical professionals would pass out when they discovered all the thrombosis that is non symptomatic. I bet I have a leg clot sitting here right now I do not even know about as I have been at my desk for 12 straight hours. Isn't the body a wonderful thing. I think of that every time I aspirate solid or liquids and fill the filter paper of the lungs with stuff or watch a dialysis catheter stripped of all that stuff you know that fibrin stuff on the outside of the catheter. Never see the PE that is supposed to occur. I guess it does happen sometime. Guess I am in a thought provoking mood tonight.
Vera if one cannot go to the other arm and there is a documented thrombosis in the one arm the question is one of a medical judgement to made with the patients MD. Yes you can use another vein but will that predispose a patient who is already prone to thrombosis to occlude another vessel. The answer maybe yes and maybe no. Another medical question is it viable to leave a thrombosed PICC in and treat it but continue to use it as the placement of a new PICC would likely result in a thrombosis. There is no firm asswer this as well. Is this a patient who should go to IR for a small bore central catheter down the jugular? I know I left you with more questions but I would have to say that a conversation with the medical staff is necessary to do a risk benefit analysis patient by patient. sometimes the benefit outweights the risk. Has what you described been done by placing a PICC in an already thrmbosed are but another vein. Anecdotally Yes. Have a conversation with the ordering physician and doucument that conversation.
wish I had a solid answer for you - kathy