PICCs and lymphedema

[alohagal]

Seeking answer(s) to PICC or not to PICC a person who has bilateral arm lymphedema requiring antibiotic therapy x several weeks. This person has also undergone post mastectomy radiation therapy. Currently, IV access has been achieved in the feet. However, this is not a viable option for sending her home to continue therapy. Any suggestions?

[iluvivt, BSN, RN]

First of all you must weigh the risk vs the benefit. If you do not find a suitable access for this patient that will allow her to get her IV abx in a timely manner and without inflicting too much harm what could happen. Unfortunately not all situations are ideal. So after closely evaluating the situation and this icludes collecting all kinds of information such as abx ordered and its chemical chracteristics,lenght of therapy,other venous access options, any po options etc. Also is one arm worse than the other or did one arm have more lymph nodes removed. Has the patient had any hx of DVT. I would also discuss this with the prescribing MD and if they wanted to still try for the PICC i would evaluate the arm with the least amt of edema and place the picc with ultrasound guidance fairly high up in the arm. Ii is also important to do good teaching with the patient and any caregivers of reportable S/sx of complications. Increased monitoring maybe needed especially for thrombosis b/c of stagnant or diminished circulation. lastly,if a nurse is still uncomfortable inserting a PICC in this type of pt one can always refer to Interventional Radiology. I have done this many times after consultation with the MD. Again one must look at the risk/benefit issues and weigh all the issues and then make the best decision for the pt at that time.