We have a pt with a non healing leg wound s/p r fem tib bypass that the dr would like to order a picc line for long term vanco. She has a left av fistula and a right internal jugular tessio dialysis cath. We are hesitant to place a r picc due to possible complications of having 2 lines enter brachiocephalic, subclavian veins. Mainly more potential of a thrombosus due to vein crowding. Would placing a picc in this pt be acceptable. Is there any data saying this can be done. thanks

the left arm fistula is still

the left arm fistula is still maturing. The tessio is actually a permanent tunneled catheter. Our dialysis clinics recently changed their policy of infusing antibiotics after dialysis. not sure why. was thought to be related to  increased chair time at the clinic. Thanks for your replies.

This option would mean that a

This option would mean that a greater length of vein would have 2 catheters both being in the IJ, brachiocephalic and SVC. A PICC would be a smaller diameter and 2 catheters would only be in the brachiocephalic and SVC. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

We just had a patient with a

We just had a patient with a simular story. The ascular surgeons slipped a central line in jugular beside the dialysis catheter. the CL was tunnelled so that the exit site was below the clavicle It semed to work well, and they were able to revove the CL without disrupting the dialysis catheter. I don't know if this is an optimal solution, but it worked.

Gail

Gail McCarter, BSN,CRNI

Franklin, NH

It is a matter of weighing

It is a matter of weighing risk vs benefits. Is the left av fistula functioning for dialysis or maturing so that it can be used? Is the right IJ dialysis catheter a temporary device? If the fistula is good and is or will be used with maturity, you should not use the left arm for PICC placement at all. You don't want to do anything to disturb that. A PICC in the right basilic vein will meet the R IJ catheter in the right brachiocephalic and SVC, but not the subclavian vein. Subclavian and IJ join to form the brachiocephalic. Vein diameter at this point is very large, but 2 caths in the same veins may increase the risk of thrombosis. But the patient needs some type of CVC to deliver the vanco. Only 1 arm to use for peripheral veins, probably are very limited number of sites on the right arm, risk of extravasation injury from vanco with all the risks that brings compared to the risk of vein thrombosis. My opinion would say go for the PICC in the right arm. All other CVC options would create the same risk of vein thrombosis but a small diameter PICC would create the least risk. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

PICC & CKD 5

I would avoid placing a PICC in a CKD 5 patient in any situation.  I'm assuming the AV on the left is either non-functioning or has not matured yet and this patient is being dialyzed via the R IJ.  The right arm very well may be needed for future dialysis, if or when the left AV fistula fails.  I would look for better options for this patient.  Is the fistula new or non-functional?  Can they get the Vanco in dialysis? 

Judy Thompson RN, BSN, VA-BC