Question? Need answer

[blsmom]

Pt. on our unit is a 25 yr. old female dialysis pt. She has a thrombus in her IJ, cephalic, and basilic vein of ® arm. Has fistula in her (L) arm with left hemodialysis cath present. She had a PICC in the right arm 2 weeks ago. Right arm has 4+ edema. Our staff asked for a femoral line to be placed. Instead Dr. wrote for peripheral I.V. to be placed for fluids and her pain meds. She was to have a CT the next day.

They were able to place peripheral #20 angio in right arm, despite the major swelling. We felt this was unsafe due to her clots in that arm and the fact you would not be able to tell if line was ever infiltrated...would also sometimes get I.V. Phenergan. Dr. said because Heparin was infusing through the I.V. it was not a problem. Labs had to be drawn either in dialysis or from her foot. Please help shed some light on this problem...Should peripheral line be placed in arm with major swelling and clots in those veins identified above????

Thanks in advance for your help

[PICC ACE]

I ran this situation by some of our IP dialysis staff. No one favored the rt arm PIV,especially not with Phenergan. What did the nephrologists have to say? Would they let you use the perm-cath for access or maybe left hand for a PIV site? I see this post is a week old---what ever happened to the patient? Very curious.....

[blsmom]

Thanks for your response. I found out she had gone home 4 days later and they started using her dialysis cath...she never had a femoral inserted.