Internal Jugular Line when Upper Arm Infection describes how the Vascular Access clinician was able to use his advanced skill set to assess the patient’s clinical history and choose the safer and more clinically appropriate Internal Jugular (IJ) line to achieve access instead of the physician initially ordered PICC line and is the focus of this Nurse Clinicians in Action. Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases generally involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician as our clinicians have the ability to consult each other while in the field, as well as an on call Clinical Administrator via a HIPAA compliant communication app. Our extensive training program and diverse client base including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities provide our clinicians a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.
Internal Jugular Line when Upper Arm Infection
– Clinical Case
This case took place in a hospital with a woman in her twenties with an upper arm infection. The infection was caused by hardware (e.g., plates and screws) in each of her upper arms that was used to help her recover from a fracture of the bilateral upper arms resulting from a prior motor vehicle accident. This hardware had caused an infection and treatment included both the removal of the hardware and long-term IV antibiotics. The managing physician ordered a PICC line as this is usually the preferred choice for long-term antibiotics.
Internal Jugular Line when Upper Arm Infection
– Diagnosis and Treatment
The Vascular Wellness clinician consulted with the surgeon and explained that the upper arm (where the PICC line would be inserted) would not be a viable choice for vascular access due to incisional wound and infection and discussed the option of an Internal Jugular Line that is placed in the neck, avoiding the patient’s upper arms. The surgeon agreed and together, they consulted with the patient’s home health medical team, which then approved the IJ. The patient’s medical team was all on the same page and the surgeon and Vascular Wellness clinician went to work.
After the successful removal of the infected hardware in the patient’s arms by the surgeon, the Vascular Wellness clinician placed an ultrasound-guided single lumen IJ via the inferior/anterior approach, and the internal portion of the catheter was placed in the lower aspect of the superior vena cava (SVC), a large vein in the chest. The procedure was successful, without any complications, and comfortable for the patient. After placement, a single anteroposterior (AP) or front to back view portable chest radiograph showed the IJ central venous catheter in the proper position in the SVC. As a side benefit, to add to the comfort for the patient, the inferior approach instead of the posterior approach allowed the catheter to be hidden with a collared shirt, especially beneficial for an active individual. Long-term IV antibiotics commenced, and the infection was treated.
Vascular Access Specialist
– Key Points
Vascular Wellness prides itself on advancing its ability to place complicated lines including small and large bore lines, at the bedside. For hospitals without Interventional Radiology (IR) services, such as in this case, the patient could be treated in the comfort of her room and the cost and transfer paperwork to transport the patient to another facility and back was eliminated as was the possible exposure to additional infections during transport or at the other facility. Even when IR services are available, eliminating transportation inside the hospital such as between floors is also advantageous.
Vascular Wellness clinicians have placed hundreds of thousands of lines and this experience enables us to assess a situation and patient properly and if a patient is contraindicated for a specific central line, to utilize that experience to place a clinically appropriate line such as an IJ when it is a safer option. Further, by having the tools of US Guided PIVs, Midlines, PICCs, Small Bore lines such as Internal Jugular lines (IJs) and Femoral lines (Fems), and Large Bore lines including Vas Caths and Quad Lumens, Vascular Wellness is able to create clinically appropriate access in virtually all patients, while minimizing multiple needle sticks. The ability to minimize sticks and place the right line at the right time, the first time, is incredibly important as the placement of a Central Venous Catheter is an invasive medical procedure that comes with risks. These factors, along with a consultative approach with the treating physician, are just a few reasons why Vascular Wellness improves patient outcomes, reduces costs, and strengthens infection control.
If you require Vascular Access or want to learn more about our services, speak to the team at Vascular Wellness today. For the latest articles and insights, follow us on LinkedIn, Facebook, Twitter, YouTube, and Instagram.