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I have received a request to administer TPN at home for a pt. that has advanced colon cancer.  He has been tapped numerous times for fluid removal.  The issue is that on CT scan his PAC is possibly in his hepatic vein-there is some uncertainty due to the fluid in his abd.  They did a catheter gram a few months ago and that report says the tip is deep in the right atrium, possibly in the IVC.  I have requested they do another one to determine tip placement prior to me accepting him for home infusion.  Obviously with his poor prognosis I'm in for a battle to get them to readjust his current PAC or insert a PICC.  He has been receiving chemo for several months and TPN for several weeks in house via this same port.  What are your thoughts?  I'm a little hesitant even if the report shows tip in the atrium-surgeons here are notorious for placing them there rather than the SVC.  Evidently he has had no issues sit his port.
Chris Cavanaugh
Would an xray show the

Would an xray show the catheter tip?  If it shows SVC or Rt atrium, and it is currently functioning, (blood return and flushes easily) then I see no problems with continuing to use this port at  home for TPN.  (I assume PAC means Port) Dialysis catheters are routinely placed in the Rt Atrium and used for reinfusion of blood at high rates, and these catheters are much larger than what would be attached to his port.

Chris Cavanaugh, CRNI

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

As it turned out, his port
As it turned out, his port was in his hepatic vein-not sure how it migrated that far-IR did attempt to reposition with no luck so they ended up replacing it.  Due to this, the TPN pharmaciists have now added to check for central line placement prior to starting TPN.  Kind of scary that he had been receiving TPN for well over a week with tip in the hepatic vein.  As far as we can tell right now no harm.
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