Or are we talking about the path in and not just the SVC? I believe there is a paper out there I just can't remember at the moment that addressed left side vs right side in.
Timothy Royer, BSN,CRNI -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Nadine Nakazawa Sent: Monday, August 14, 2006 10:10 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: Left arm thrombosis I'm not sure, but I'm thought that the higher incidence of left sided thromboses had to do with suboptimal tip placements from the left with the tip impinging against the far superior vena cava wall. With MST and US, it is always possible to get to the distal SVC or the caval-atrial junction. That is our goal with PICC insertions at our facility. I'm not sure why your colleague would place the PICC close to the AC, as patients complain that the PICC is uncomfortable there. We place it at least 4 cms above the AC to better secure the PICC, and for patient comfort. All excess PICC is secured on the upper outer aspect of the arm. With tall patients, you always have to move up the arm, but they have a long arm anyway. Nadine Nakazawa >From: "Zenger Rhonda" <[EMAIL PROTECTED]> >To: [EMAIL PROTECTED] >Subject: Left arm thrombosis >Date: Mon, 14 Aug 2006 10:14:32 -0500 > >I apologize for not being clear with my question. What I am trying to >find out is there any research based information regarding an increased >incidence of thrombosis and/or complications when using the left arm >for PICC placement. In the past, we would visualize both arms with >ultrasound and then choose the arm with the best vein for access. >However, I attended a workshop in Kansas City and the speaker reported >an increased incidence of thrombosis is associated with using the left >arm. He recommended the using the right arm first unless >contraindicated and then using the left arm. Now, we use the right arm >for PICC placements unless there is a contraindication then we use the left arm. >One of our team members continues to use the left arm no matter what >the situation is because the CRNAs have informed her it is the easiest >and best approach. She also uses a close to the AC approach on the left arm. >This makes it very difficult to take care of the PICC due to its >location close to the AC. I am trying to change her practice approach, >if possible. If anyone has any literature or information to support not >using the left arm routinely and not choosing a low AC approach for >PICC placements it would be helpful. We use ultrasound with MST. > >Thanks so much, > > > >Rhonda Zenger, MSN, RN > >Advanced IV Services > >Mercy Regional Health Center > >Manhattan, Kansas > >785-323-6835 > >[EMAIL PROTECTED] > > >
