Is placement of triple lumen CVCs and a-lines in the upper arm for IV access supported in the literature? Has anyone seen this in their practice?
Are you asking about a subclavian or IJ inserted CICC and an arterial catheter in the brachial artery? Or a triple lumen PICC and a brachial artery catheter? Radial artery is the first choice in adults but brachial can also be used. Triple lumen PICC is questionable on its own if the catheter fills more than a third of the vein diameter. PICC and brachial artery sites that close together would be high risk for accidental infusion of fluids and meds into artery! No absolute contraindication but complication at both sites could be high risk for that extremity. What were the other options for these lines? It all comes down to risk vs benefit for each patient which is based on assessment and judgment.
Lynn Hadaway, M.Ed., NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Thanks Lynn. To clarify, this was actually a triple lumen CVC that is used for IJ or subclavian central line placement placed in the upper arm and used as peripheral access from what I can gather. The tip was in the subclavian region. There is no documentation as to which vein was used.
Well, there are so many deviations from the standard of care, that use of a brachial arterial catheter is the least of your worries. The first and most dangerous point is that no tip of any CVAD should ever be left in the subclavian vein. The risk of vein thrombosis is extremely high. This can become an occluded thrombosis or it can embolize. The correct tip location is the cavo-atrial junction or the lower third of the SVC. The catheter size is another risk for vein thrombosis as the CVADs designed for subclavian or IJ insertion are larger outer diameter. The catheter should consume no more than a third of the vein lumen as measured by US. Anything larger has a higher risk of vein thrombosis. I would work toward getting this catheter out as fast as possible.