SCENARIO--A PICC has been ordered for a patient. Patient is assessed and found with bilateral upper arm burn scars/skin grafting, which also extends well to the axillae. Patient also with limited range of motion and mobility BUE due to scarring/grafting. For the heck of it, also assessed very limited areas of bilateral upper arms NOT affected by burns and grafting with ultrasound and veins found were inadequate in size for 4 French PICC. Veins were then assessed more proximal into the burned/grafted area and were found to be very large, but I would have to place PICC into the scarred/grafted area. Discussed with ordering service, I recommended a Power Line (tunneld/cuffed catheter) as patient needs 6 week course of IV antibiotics.
QUESTION--Would it have been appropriate to go ahead and place the PICC into the scarred/grafted area??? I do not believe so and did not place a PICC. Just wondering what everyone else may have done!!! Thanks.
I would have made the same assessment and nursing judgment as you did. I would not want to insert through the scarred/grafted area and think a tunneled cuffed VAD is the most appropriate for this patient. 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
As always, thanks for your input Lynn :)
Jeannette Andrews, RN, CRNI, VA-BC
Out of curiosity, is this an acute burn or one that has healed? was it a donor site or a burn injury site? just wondering
Hi Jill-it was healed, not acute with some grafting and some scarring.
Jeannette Andrews, RN, CRNI, VA-BC
Thanks. Your question got my thinker in gear, how much function does that skin have? can it repair? that kind of thing. Definitely I wouldn't place a PICC in scar tissue but if options are limited and on burn patients they sure can be, is virgin skin a requirement for placement? and talking skin, what about tatoos? Do you stick through tatoos? Some of these people are coming in with so many now. I saw a woman with a PICC placed through her psoriasis and very deleterious result. Maybe we need to talk more about skin. I appreciate your question so thanks!