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deedee
Where to put the central line

Hello everyone I had a situation come up with a pt. The pt has had multiple central lines in the past(port a caths, picc lines) and she has multiple thrombus's so they are unable to place a line in her chest. She has lyphedema in both arms. She is on navelbine which she is responding to. So I am asking what do we do when they cant put a line in the chest, but they do need a central line?

afruitloop
Usually the subclavian is
Usually the subclavian is what is thrombosed so you may be able to place a line in the right jugular and drop it to the SVC, thus by-passing the subclavian.  IN my past ecperience, I have done this successfully.  Since access is difficult, you may want to guide the physician towards an antimicrobial catheter, thus giving the patient protection  against infection.

Cheryl Kelley RN BSN, VA-BC

lynncrni
I would recommend a
I would recommend a consultation with an interventional radiologist who can place a catheter through the transhepatic or translumbar veins with the tip positioned in the inferior vena cava. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

momdogz
One of our patient's had a
One of our patient's had a transhepatic groshong for over a year for similar reasons - worked very well for her.

Mari Cordes, BS RN 
Nurse Educator IV Therapy
Fletcher Allen Health Care

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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