I have a physician insisting that we place a picc line for a patient needing long term IV antibiotics who has had a right radical neck dissection and lymph nodes removed from the left as well as a pacemaker on the left (greater than 3 months). We felt this patient would be better served by a tunneled CVC (port or Groshong). the physician says we are being "over cautious" and he can understand axillary lymph nodes but we should be able to place the picc due to lymph node removal from the neck only. Thoughts? I need to provide him proof that we shouldn't do this if you can give me some leads to find this, I would greatly appreciate.
I agree with the physiscian. There is very little evidence that axillary node dissection and VADs in that extremiety leads to lymphedema but the standard is still to avoid any venipuncture in the same arm. But neck dissection has never been an absolute or a relative contraindication for a PICC. In fact, neck dissection would prohibit or hamper jugular or subclavian insertion so a PICC would be the most aprpropriate choice, given the limited information in your original message. As you know there are many other factors to consider. I have never seen any evidence to support not placing a PICC in a patient with a neck dissection. 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