picc in subclavin...o.k for some chemo drugs?

[blsmom]

If the Picc is short and only in the subclavin vein, can some types of chemo still be given. Which ones?

Thanks

[HemeNP, MSN, RN, NP]

You have to make sure if the subclavian line is a PICC (longer) or an angiocath (shorter) that was inserted through the subclavian vein. If you are sure that it is short (meaning it doesnt extend to the SVC) then personally and our hospital policy will not give/allow us to administer continous infusions of vesicant solutions. we may give vesicant drugs by iv push. Most subclavian PICCs extend to the SVC. Midline catheters which are usually located on the upper extremeties don't extend to the SVC. Please make sure where the catheter tip is located by xray confirmation. That way ur sure if it's "long" or "short". It will be safe to consult with ur peers, CNS or charge nurse and hospital policy. for more info u can check out the INS (infusion nursing society) and the ONS (onc nsg soc.) websites. hope this helps.

[CritterLover, BSN, RN]

if the picc is short and only in the subclavin vein, can some types of chemo still be given. which ones?

thanks

i don't leave piccs in the subclavian vein (or the brachiocephalic veins). in that location, they are considered to be "midclavicular" lines, not piccs, and ins does not consider midclavicular lines to be safe.

the problem is that they have fairly high rates of dvts. some of my collegues will leave them there, but i can't see how that can be justified when the higher dvt rates are pretty well documented, so i don't leave them there.

would the picc not thread the whole way, or was it too short? if the picc is too short, then i do a wire exchange with a longer picc to get it in the right spot. if i can't get it to thread, then i send the patient to ir, where they can manipulate the line under fluoro, or do a dye study to see if there is an occlusion. another option would be to pull it back to a midline, which are considered to be safe.

i'm sorry, i realize i'm going off on my own tangent and not answering your question. if your hospital policy allows midclavicular lines, then i guess the answer would be that only non-irritants, non-vesicants can be given through one, since you don't want to compound the dvt issue by damaging the endothelium with an irritant or vesicant. pharmacy should be able to tell you if the particular chemo drug is an irritant or a vesicant. most are. as for the midline, any chemo that can be given through a piv can be given through a midline. a midline would probably be a temporary solution, though, since most facilities require that any iv that has chemo infusing through it must have blood return, and midlines don't seem to maintain blood return for very long.