I agree.......but is he even stable enough to go to IR??? >>> "DAVID LONGSETH" <[EMAIL PROTECTED]> 10/26/2006 1:21 PM >>> I would think a fem line for this guy would be too risky--between the MRSA and the fact that he already developed a clot around one line,that would be asking for more troubles. IJ is probably out,too--his clotting/platelet issue is such that he has one big bruise from the chin to the neck to the clavicles due to the trach placement and the trach collar would be right on the insertion site. Subclavian? That's probably the next best alternative but they darn well better let IR do it with US guidance--no blind sticks for this guy.
>From: "Laura Cook RN" <[EMAIL PROTECTED]> >To: "Lynn Hadaway" <[EMAIL PROTECTED]>, "DAVID LONGSETH" ><[EMAIL PROTECTED]>, [EMAIL PROTECTED] >Subject: Re: PICC with thrombus >Date: Thu, 26 Oct 2006 12:40:28 -0400 > >I'm thinking, would it not be better to have a subclavian, IJ or femoral >placed and remove the PICC? To at least give the clot some time to resolve >and maybe the patient some time to stabalize? > > >>> "Lynn Hadaway" <[EMAIL PROTECTED]> 10/26/2006 10:43 AM >>> >Very tough situation but here is what I thought of: >Aspirin is a pretty good antiplatelet drug, so this may keep the clot >from growing, maybe. >Many risk factors are present to cause a DVT - third spacing (severe >extremity edema) probably leading to systemic fluid volume deficit, >diabetes = hypercoagulability + large 6 Fr PICC >Seems like the best thing you can do is leave the current PICC and >closely monitor the clot. When he becomes more stable, and if the >clot worsens, you may have other options. I would personally want to >monitor this patient and not leave this one to his primary care >nurse(s) alone though. > >Eager to read the thoughts of others. Lynn > >At 9:31 PM -0500 10/25/06, DAVID LONGSETH wrote: > >Had a patient today with the following scenario: > >Admitted 10/14 to MICU from a nursing home with multiple,multiple > >problems. Respiratory failure with MRSA in lungs,renal > >failure,CHF,GI bleed,diabetes. Trach'ed a few days ago,on > >ventilator. Also some sort of undiagnosed 'platelet problem'--normal > >PLT levels but prolonged bleeding times. Basically a very very sick > >guy. Because of the bleeding problems,he can get no anticoagulation > >beyond an aspirin down the dobhoff. > >6Fr Triple Lumen Power PICC placed 10/16 in right basilic about 2" > >above ACF--routine procedure,tip into lower SVC. Asked to look into > >patient today. Both of his forearms have +3 edema from ACF to hands. > >Doppler showed thrombus in right basilic around the PICC. Right > >upper arm looks fine-no swelling and in fact the circumference is > >3.5cm LESS then when line placed. No palpable phlebitic vein. Both > >forearms are EQUALLY swollen. > >The issue is whether to leave the current PICC or place one in the other >arm. > >My views are thus: his right upper arm is essentially asymptomatic > >and the PICC is not causing the forearm swelling,it's the CHF/ARF;of > >all his problems,swollen forearms are pretty minor;this is not > >acting like a septic thrombophlebitis;whether the PICC comes out or > >not,the thrombus is still there and the risk for PE is still > >there,PICC or no PICC;there's no guarantee that a different PICC > >will not develop a thrombus and in that case he will have not only a > >known thrombus but yet another line at risk for developing more;his > >left arm veins are barely big enough to safely accomodate a 5Fr line > >anyway. My conclusion--the risks for placing another line are at > >least equal to if not greater than leaving the current one. > >I welcome any guidance,opinions or insights from the group. > >Regards > >David > > >-- >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 > > > >----------------------------------------- >This message and any included attachments are from CaroMont Health >Inc. and are intended only for the addressee(s).The information >contained herein may include trade secrets or privileged or >otherwise confidential information. Unauthorized review, >forwarding, printing, copying, distributing, or using such >information is strictly prohibited and may be unlawful. If you >received this message in error, or have reason to believe you are >not authorized to receive it, please promptly delete this message >and notify the sender by e-mail with a copy to [EMAIL PROTECTED] > > >
