Yes, this would make a great article as well as a VERY interesting presentation at AVA or INS. Many of us only deal with the occasional pregnant patient, and do not always consider all the changes that may be occurring and how they effect care.
Chris Cavanaugh, CRNI 407-928-9297 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Earhart, Ann Sent: Tuesday, July 03, 2007 11:10 AM To: Henderson, Karin; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: STAT request to PICC experts We used to see this a lot in our patients who are pregnant. Our facility delivers 800 babies a year, so we see a lot of these gals. Even though standards recommend lower 1/3, we have found that these patients have pressure in this area due to the increases blood flow. First we make sure with PA and Lat x-rays that the tip is SVC and not posterior or some other variant position. From here, adjust the PICC to the mid to upper 1/3 of their chest until they feel no further chest discomfort. As the size of their baby increases, it pushes the diaphragm up into their chest, causing more pressure. Add to this their nausea, and you have one miserable patient. Even though the standard is the lower 1/3 of the SVC, these patients you have to take into account their symptoms and their pregnancy, as well has their hyperemasis. We've made a practice to place the PICCs in our pregnant gals (with the permission of our Obstetric-Gynecology Committee) to be mid to upper 1/3 just because of all of our documented cases of palpitations and pressure from their PICCs in the lower SVC. We've had no problem since. Sounds like this would be an interesting article!! Ann Earhart, MSN, CRNI, APRN-BC Clinical Nurse Specialist-Adult Health Vascular Access/PICC Team Banner Desert Medical Center Mesa, Arizona 85213 office-480-512-3980 pager-602-420-3240 e-mail: [EMAIL PROTECTED] _____ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Henderson, Karin Sent: Tuesday, July 03, 2007 5:44 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: STAT request to PICC experts We have seen this once...it ended up being anxiety. We just did another x-ray to reassure the patient that it had correct placement. Karin Henderson RN, MSN, CCRN GNP Direcotr Vascular Access Services Moses Cone Health System _____ From: [EMAIL PROTECTED] on behalf of [EMAIL PROTECTED] Sent: Mon 7/2/2007 7:04 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: STAT request to PICC experts I have a 24 y/o female with hyperemesis 11 weeks gestation. A PICC was placed Thursday. She had a sudden sharp pain in her chest on placement that diminished. But now it is getting worse. She has difficulty taking a deep breath. The pain is center chest and increased with even mild exertion. Any thoughts about what is going on? Thanks, Lynda Cook, CRNI Greensboro, NC _____ See what's free at AOL.com <http://www.aol.com/?ncid=AOLAOF00020000000503> .
