U/s IV same arm as PICC

[Urgirlconnie2014, BSN, RN]

Okay, I had a patient today who pulled out his PICC line on the right arm and it had a huge hematoma, so I obviously didn’t want to use that arm for IV or blood draws. The PICC team was called to put another one in but it was gonna take them a LONG time so my charge put in an u/s IV in the left arm, the arm that I assumed they were going to use to put another PICC in. Will they still be able to put the PICC in okay? 
 

The reason I ask this is because I know PICC is obviously a peripherally inserted CC, so they snake the PICC into the basilic, brachial or I think cephalic vein and then snake it further in until they reach the heart. I’m pretty sure the vein they used for the IV was the basilic or brachial vein (I’m not super great at remembering the diff) so if there was an u/s IV there in the vein already, wouldn’t that prevent them from putting the PICC in? I mean, I know they have options but wouldn’t putting an ultrasound IV in the left arm reduce one of their options? Also, real estate too because there’s not a lot of space between those veins and what if someone has crappy veins already and you’ve taken away one of their choices for a picc placement? I don’t know, maybe I’m reading too much into this. I wanted to wait for the PICC team to place the line first since his vitals were stable but I was overruled. Also, someone also said they’d put the picc in higher up but those ultrasound IV catheters are long too. PICC nurses, clarify for me please. It’s been haunting me enough that I made an account to post on this site. 

[Guest219794]

I am not a PICC nurse, but if the existing PIV is in the way of a PICC, the PICC team can pull out the PIV.

 

[LibraNurse27, BSN, RN]

I've had patients with a PICC line in the upper arm and a peripheral IV in the same arm in forearm/AC/hand. It wouldn't be in the way unless it's in the same vein they are going to use for PICC (usually basilic vein) or somewhere else in the upper arm that might make placement difficult. And, if it's in the way they can take it out ? No need to worry! 

[iluvivt, BSN, RN]

It's always best to consult with the PICC team. As a PICC nurse I would  have been preferred to be called so I could assess the situation. You do not necessarily have to switch arms just because an existing PICC was pulled out.You can go  above the hematoma, assuming the vein is collapsible and it's asymptomatic.If it's not then the left side,in this case, would need to be assessed. We do ask our nurses not to use the PICC veins for USGPIVs.Yes, I do understand that you can take it out but then you would have to start another peripheral (I like to have an access in place for the procedure,just in case and the patient gets poked again).The other factor is that that if you use a PICC  vein ( Basilic, Brachial or Cephalic) the vein has now had trauma/injury. Remember Virchows triad? One aspect of the triad is vessel trauma and that will theoretically increase the risk for thrombosis.I would prefer a virgin vein! I would have asked you to try to establish a PIV below the ACF in either arm and call back for help if you could  not get it.Then I would have helped if needed. That is the ideal situation!