We have a facility in our area that places L-lines (long lines, subcalvian tip placement). The facility that I work for does not leave any catheter tips in the subclavian vein. The problem is we have an outpatient who came to our facility for a diffierent procedure and we noticed that his line was not optimally placed. Our delima is do we leave the line as is since it has been in place and already used for 3 weeks or do we do perform an exchange or new PICC placement? Which is more deteramental to the patient? Pateint has history of difficult venous access.
Thanks,
Rose
Any advise on this would help. We attempted an over the wire exchange hoping to put the tip in the SVC but could only place a Midline with tip below axilla.
Rose Galyan RN, BSN, CRNI
Speciality Practice Nurse
Vascular Access Team
Indiana University Hospital Bloomington
[email protected]
Your inability to exchange this midclavicular for a PICC suggests that there is some type of venous obstruction, probably a vein thrombosis caused by this tip location. I would want to know what is going on through a diagnostic ultrasound at least. If that is positive, it would be a medical decision as to what other diagnostic tests and possible treatment would be necessary. US is noninvasive and would tell you if there is a thrombus present. 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
Thanks Lynn,
That was my thoughts also. The patient was at our facility for outpatient surgery only and the medication he was getting was okay via the midline.
My thought was should I have left it as is since it was already in for 3 weeks? I just wonder if I stirred up more trouble than benefit for the patient.
Rose Galyan RN, BSN, CRNI
Speciality Practice Nurse
Vascular Access Team
Indiana University Hospital Bloomington
[email protected]
VEry hard to answer that question until you know the final outcome. If thrombus is present, it may resolve without intervention. So if all is well, that may be enough. But if he needs further IV therapy now or in the future, this thrombus could lead to stenosis and narrowing that may present future problems for this patient. Sure wish you could share this experience to have some influence on those that are practicing outside of the standard of care by using this midclavicular tip location for infusion. 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