Yes, the same reasons for not placing a PICC would also apply to a
midline in this patient. In the right side with the weakness, do what
extend does the patient move this extremity independently? Is it a
paralysis or just a simple weak grip? Paralysis means that the muscle
pump action is gone. This is the action that causes blood to move
back to the heart. If there is any edema in this extremity, this
indicates that there is impaired circulation. So I would not choose
this extremity for either a PICC or midline. Also with a midline, you
would be concerned about the therapy characteristics and their
likelihood for causing chemical phlebitis -pH, osmolarity, vesicant
nature, etc. Lynn
At 10:32 AM -0700 4/25/06, Duryea Tracy wrote:
Hello, all,
Our PICC team received a request to place a PICC in a patient who
has a large, non-functioning, tortuous AV fistula in the left upper
arm and a history of right-sided weakness due to a CVA. Despite the
right-sided weakness, this patient has a Swan-Ganz in the right
jugular and permacath in the right subclavian. When we refused the
placement, the MD became upset even after it was explained to her
that the patient's co-morbidities ruled him our for bedside
placement. She then preceded to order placement of a midline. Our
question is this: Are the contraindications PICC placement extended
to midlines? What is being done elsewhere in this respect?
Your help is much appreciated!
Chris Tracy, RN
Artie Hansford, CRNI
Alta Bates Summit Medical Center
Oakland, CA
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
