By all means,Nadine.
As it turned out,right arm PICC was removed and another placed left arm. I
haven't checked into thngs beyond that. So,we'll see...
David
From: "Nadine Nakazawa" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: RE: PICC with thrombus
Date: Mon, 30 Oct 2006 14:01:21 -0800
I agree with your assessment. He may be at risk with a second PICC. I'd
discuss risks with MD team and with patient and family. Document your
findings and observe daily. No easy answer, but we want to err on the
side of the least harm to the patient. Sounds like you're looking at
everything from all angles.
Save your email description. It makes for a great teaching story. Pose
it to your nurses and ask what they would do. BTW, can I use it in a
class??
Nadine Nakazawa
From: "DAVID LONGSETH" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: PICC with thrombus
Date: Wed, 25 Oct 2006 21:31:57 -0500
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
