I agree completely with Leigh Ann. I just finished putting in a very difficult PICC in a patient who came at 2 PM from the outpatient cancer center with a report that she had "green junk" at her PICC line exit site, and the MD wanted a PICC nurse to evaluate it. I looked at it, and indeed it looked like a green exudate at the exit site. I paged the MD and got orders to: culture the green stuff, tip culture (intracutaneous and distal tips---it takes two nurses and at least 2-3 scissors), and 2 sets of paired blood cultures (drawn peripherally). She had a bad skin reaction to either the Chloraprep or transparent dressing. I attempted her right arm at least 4 times, but could not even get the wire in til the last attempt, and then it got stuck in the axillary vein. She has had 1 implanted port (for chemo awhile ago), and 2 PICCs. I put the first PICC in a year and a half ago in the R arm---she said it went in easily, but got infected at the exit site after 1 year. She got a new PICC in June that lasted 2 months til this green yucky stuff.
She has end-stage ovarian CA and is on home TPN. She desparately needs the central access, and begged me to keep trying. I went back to the Left arm, and looked a sites away from the infected area and vein. Her basilic vein would not compress, and I hit the nerve while trying for the brachial vein (the other one was under the artery). I finally got in the cephalic vein (rarely use cephalic any more). It was now 7:30 PM, and the radiology techs yelled at me for bringing her over without calling first. I always bring outpatients to Radiology without calling first and they always take the patients (sometimes we have to wait a bit). The late evening crew is just not as nice as the day/early evening techs.
I went back to the Coronary Care Unit to try to decide what to do with a patient one of my 8-hr PICC colleagues tried to do today. She could NOT see the PICC tip despite manipulating the PICC twice and 3 CXRs. He's got cardiomyopathy, has very wet lungs due to fluid overload, he's a bit obese with an AICD. It's the wet lungs and AICD wires that obscured the CXRs. He was too fragile to go to the Radiology Dept for CXRs, so she was stuck with the portable CXRs. sometimes, despite our best efforts, things just do not go smoothly.
I am now trying to finish my last PICC (he was my first one today), but he's on the bedside commode, and he's MRSA. This rambling is a good example. so to kill time, I'm doing the venous listserv email. This is a good example of a bad PICC day. Maybe I can find a job I'm really good at---like flipping burgers at McDonalds...something mindless and I'll always be successful...
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: Re: question about CT
Date: Thu, 10 Aug 2006 21:51:06 -0400
Absolutely. I am concerned anytime we put in a central line that could be avoided, and especially when we leave one in without any ordered use for it. Remember that frequently placed lines or lines left in place for extended periods increase the risk of neointimal hyperplastic venous stenosis, something we see A LOT in our facility. We have patients who are literally dying for lack of access, due to no viable pathway available for a catheter.Leigh Ann
-----Original Message-----
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Sent: Wed, 9 Aug 2006 11:22 PM
Subject: Re: question about CT
If placing a PowerPICC just for CT, you have to look at the total patient: Do they really need a central line for anything OTHER than the CT? Otherwise putting in a PowerPICC and leaving it there is too great a risk for very little benefit if they have no other IV access needs.
Nadine Nakazawa
>From: [EMAIL PROTECTED]
>To: [EMAIL PROTECTED], [EMAIL PROTECTED], [EMAIL PROTECTED]
>Subject: Re: question about CT
>Date: Wed, 09 Aug 2006 22:42:48 -0400
>
>We do the same as Nadine.
>Leigh Ann
>
>
>
>-----Original Message-----
>From: [EMAIL PROTECTED]
>To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
>Sent: Wed, 9 Aug 2006 7:44 PM
>Subject: RE: question about CT
>
>
>No, but we do use ultrasound sound to place a peripheral 20 g angio right >above the antecub.
>
>Obviously this is only by someone trained in US.
>
>Nadine Nakazawa
>
>
> >From: "Denise Harper" <[EMAIL PROTECTED]>
> >To: [EMAIL PROTECTED], "listserve" <[EMAIL PROTECTED]>
> >Subject: question about CT
> >Date: Wed, 9 Aug 2006 13:05:32 -0700 (PDT)
> >
> >If you have a patient who needs a CT (that HAS to be power injected) and > >you absolutely cannot get a peripheral IV (even with ultrasound) do you > >place a power PICC for a 1 time procedure?
> >
> > This question has come up twice today.
> >
> > Thanks,
> > Denise
> >
> >
> >---------------------------------
> >Talk is cheap. Use Yahoo! Messenger to make PC-to-Phone calls. Great >rates >starting at 1â/min.
>
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