Published Jun 2, 2009
Ok, I have this pt that had PICC placement done. CXR states the cath tip is in the left innominate vein. (Due to pt's hx of cancer w/mets the tip will not advance to SVC on both arms.) Anywho, doc said this PICC was ok to use. I did not feel comfortable drawing blood considering this IV is not truly a central line, so I got the lab draw instead. Am I wrong?
Drawing blood is not the issue. It is wether or not the vein it is in can withstand chemo or whatever medication to be put into the line. And right off I couldn't say if this is a good placment for all medication. The doctor seems to think it is ok. Is he familiar with picc's?
Yes, I also feel as if this line would be questionable for harsh agents such as chemo etc. However, drawing blood is also an issue, as we all know that doing so from a peripheral line can potentially collapse the vein and would ultimately damage the site itself. Did the lab use this line to draw up the blood or did they use another site and poke the pt. I think I would feel more comfortable with the latter.
FireStarterRN, BSN, RN
This pt sounds like a good candidate for a porta-cath.
Drawing blood from this line should not be an issue as the innominate vein is a large vein formed by the junction of the internal jugular and subclavian veins.
While technically not a central line, this is a large vessel; the innominate vein is a large vessel that does empty directly into the superior vena cava. If the doctor prescribing the chemotherapy (as opposed to the doctor who read the x-ray) believes that placement is acceptable, I would not have problems using it.
I agree that a porta cath would probably be a much better choice, but if they were unable to advance the PICC on either side, placing the porta cath might be problematic as well.
Daytonite, BSN, RN
the left innominate vein (brachiocephalic vein) is formed when the internal jugular and subclavian veins merge. superiorly, the innominate vein becomes the superior vena cava. here is a picture showing the anatomy (its #3 on the drawing and #1 is the superior vena cava). http://www.pediatriccardiacinquest.mb.ca/ch02/ttlanomalous.html
this is a central line and all precautions of a central line should be observed. it was ok to draw the labs from the line.
subee, MSN, CRNA
Venous blood is venous blood - regardless of which vein cannulated.
Venous flow is toward the heart-you have lots of flow at the innominate. This line is fine for all draws and treatmenets. I'm not an expert on chemo but before the current infatuation with PICC lines chemo was given routinely through large bore periph IVs until a Mediport could be placed by a surgeon. You can draw labs from a #20 in the hand if you do it slowly and flush well afterward- It often shortens the usable life of the peripheral IV in the hand, but in the innominate... it's a central vein-thus a central line. Hate to say it but you put your patient through an unnecessary stick. Do you trust your medical staff? The doc said OK- I would be annoyed if I had been the patient and my nurse over-rode the physicians OK to use the PICC line and made me undergo a needless stick.- not to mention the waste of staff time to come up and draw the patient. The most I would have done is affirm with the OKing doc that the line was good to draw from while you had him avail.
iluvivt, BSN, RN
granted it is not an optimal tip placement BUT it is not always possible to advance a catheter into the SVC for pathophysiological reasons. usually the other side has been tried or for some reason can not be used. The other posters are correct IF a PICC would not advance into the SVC another type of CVC may not either. A Port has the portal chamber,but that is attached to a catheter that has to be threaded into the SVC as well. We just had a case like this where we placed a PICC in the upper SVC b/c it would not advance further...so we send patient to radiology to try and advance...they could not do it either b/c the patient had some kind of pathology. YES you can draw blood from these lines...think about it...the tip is still sitting in a very large vessel and t would be better to draw from it then to damage peripheral veins...think venous preservation..you will still get good hemodilution in the brachiocephalic vein (innominate) vein. Just to be safe notify MD and get an order to use it and make sure reason why it would not advance and/or what was tried and limited options discussed in the charting b/c the patient WILL be at an increased risk for thrombosis...that is what you will need to document that you instructed the pt or family on the s/sx of venous thrombosis as well as other potential complications and monitor for them. Studies also show all complications are increased with tips out of the SVC...but you always have to look at risk vs benefit.....so do some critical thinking and you will see it is still better to use it in most cases
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