Port a cath was my first (and only) thought about what you meant. Sorry, my thoughts dwell on what I'm most familiar with. As Lynn says, careful assessment, risk vs benefit etc. Those are assessments you would make for each catheter insertion. But the question was about both lumens dwelling in the distal SVC. I've never read about entanglement, but anything's possible. We had a picc that somehow tied itself in a knot. Who knows how that happened!
It doesn't happen frequently that a patient would need more than one type of central access, if it did I would question the criteria for evaluation. The course of an illness isn't always completely predictable. On 6/6/06, Lynn Hadaway <[EMAIL PROTECTED]> wrote:
2 catheters residing inside the SVC is done but should be reserved for those rare times when it is in the patient's best interest to do it - risk vs benefit assessment. I don't know how you are using the abbreviation PAC as this could be many things. What were your reasons for thinking this PICC was unnecessary and why did the physician want it? As Leigh Ann stated in a previous message, we are the vascular access consultants and as nurses we must do our own assessment and not be forced into doing something simply because it was ordered. Lynn At 8:17 PM -0700 6/5/06, Karen Douvillier RN wrote: > Here is a situation the I encountered today and was not happy with. >A doc ordered a PICC on a patient with a PAC. The patient, of course has >the PAC in the distal one third of the SVC. I was instructed to place a >PICC. I didn't think this was a good idea simply because BOTH lumens would >have resigned in the distal one third of the SVC and I was afraid that the >PICC tip could cause a little bit of a problem with entanglement should this >happen. The reasons for wanting BOTH didn't make sense. > >Has anyone ever done this...both lumens in the SVC? If so why? I didn't >want to do this because I felt that this was unnecessary. > >Please...give feedback. The radiologist said it is done all of the >time...but it's my license should something go wrong and I wasn't >comfortable. > >Karen >San Clemente, CA > >-----Original Message----- >From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] >On Behalf Of Gwen Irwin >Sent: Monday, June 05, 2006 6:06 PM >To: [EMAIL PROTECTED] >Subject: Re: Arterial sticks > >Nina, >We don't have a policy for this, but the PICC nurses know when they have >inadvertently accessed an artery and document this and their response. It >has occurred, but their response is immediately to remove the PICC and >therefore, the access site and hold pressure x 5 minutes, then document the >distal pulses after the occurrence. >However, we have also had a few that were not arterial, but had such a brisk > >blood return that we reacted to that and REMOVED the PICC. We have learned >from that also. >I do not have references that relate to arterial hematomas, like you asked. >Gwen Irwin >Austin, Texas > >----- Original Message ----- >From: "Nina Ainslie" <[EMAIL PROTECTED]> >To: <[EMAIL PROTECTED]> >Sent: Friday, June 02, 2006 12:23 PM >Subject: Arterial sticks > > >> We are developing a competency to follow for inadvertent arterial >> sticks, and arterial cannulation when performing PICC insertions. Does >> anyone have references related to arterial hematomas? >> >> Nina Ainslie, RN, BS, CRNI >> Infusion Nurse Specialist, PICC Services >> >> This message may contain confidential information protected by law >> through attorney-client privilege or professional peer review/quality >> evaluation privilege. It is intended only for the individual or entity >> named above. It is prohibited for anyone else to disclose, copy, >> distribute, or use the contents of this message. If you received this >> message in error, please notify the BCHS Privacy/Integrity Office at >> [EMAIL PROTECTED] or (269) 966-8017. -- 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
