This is a dangerous situation that might easily result in
extravasation injury. The pathophysiology is obstruction of the fluid
flow through the vein with the clot leading to increasing pressure in
the vessels used for infusion and overflow of the infusate from the
venipuncture site. This easily occurs when there is a venous thrombus
upstream or lymphedema compressing the veins.
The 3% NaCl has an osmolality of 1026 mEq per liter, so there
could be extreme damage if there should be an extravasation of this
fluid into the subq tissue. Is there any edema at all in this
extremity? How frequently is the nursing staff assessing the PIV site
including checking for a brisk blood return?
The thrombus is in the basilic vein and the PIV could be in a
cephalic vein and this may be the way to avoid the extravasation. To
infuse all fluid through a PIV in the opposite arm would be even safer
and a central venous catheter would be the safest of all situations
probably.
I have also never seen 3% NaCl infused for 4 days and this sounds
very strange to me. How and why is this patient loosing so much sodium
or not able to maintain his serum sodium levels. I have infused a lot
of this fluid and never seen if infused for more than a few hours or a
max of about 250 mL. I would have to be closely monitoring his sodium
level and question this order. Lynn
At 7:00 AM -0800 10/31/06, [EMAIL PROTECTED] wrote:
Quick question.
ICU pt s/p DL PICC in R arm, developed DVT in basilic vein. One port clotted off, the other had a blood return. The intensivist actually ordered to continue using the good port, despite the DVT, however, peripheral access was obtained, and I pulled the line.
The nurses now have 3% NS running into a PIV below the DVT, and this has been running since the PICC was d/c'd 4 days ago. I've recommended central line placement several times, however, the MD refuses, and I'm reluctant to place a second PICC in the other arm.
Is there any protocol/evidence-based practice to back up PIVs being placed below DVTs?
Any guidance would be helpful. Thanks.
Leann Kennedy, RN, BSN
PICC RN
Office/Voice Mail: 650-299-2264
Pager: 650-254-7758
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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
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
