PICC Vascular Access Cases

Vascular Access and Patient Collaboration | NCIA-14

PICC Vascular Access Cases: A patient battling cancer had a suspected infection in an implanted port catheter in her right chest wall, and a right arm access restriction due to previous right mastectomy with lymph node removal. She also had an edematous left arm from multiple failed Peripheral IVs and infiltrations, and an ongoing need for pain control and total parenteral nutrition (TPN). The patient and her family were nervous about the removal of the suspected infected port, which would be another painful procedure given her difficult IV access (a DIVA patient), as her left arm was swollen due to multiple infiltrated IVs. The Vascular Wellness clinician was consulted and reviewed the patient’s medical history, and listened to the patient’s goal to leave the hospital with the ability to receive pain medication and TPN at home. The clinician shared that even though a PICC is typically not needed in the presence of an implanted port, a benefit of the PICC was that it would not infiltrate like the PIVs, and it would be inserted only after the administration of a local anesthetic for comfort. The patient and her family were pleased with the consult, they understood the benefits of a PICC line in this scenario and felt comfortable proceeding despite their initial hesitation. The clinician performed an ultrasound assessment of the left arm, confirmed appropriate vessels for access even in the presence of the edema from the infiltrated IV sites, and successfully placed the PICC. The procedure went smoothly, and the family was so grateful that they had the benefit of a Vascular Access Specialist who would take the time to advise and advocate for the best solution to their unique scenario. After placement and the ensuing treatment initiated, the patient was discharged home to be with her family with her PICC in place.

Vascular Access for Cardiac Rehabilitation Patient | NCIA-22

PICC Vascular Access Cases: While an elderly man was recovering at a Short-Term Acute Care Hospital after a successful quadruple bypass with a valve replacement procedure, he developed pneumonia, post-operative swelling, and atrial fibrillation. The patient became frustrated with these setbacks, and it grew as his condition didn’t improve, which resulted in repeated labs and numerous painful blood draws. Although his cough persisted, it was eventually decided to remove his IVs and transfer him to an inpatient Cardiac Rehabilitation Hospital. While in the Cardiac Rehabilitation Hospital, an X-ray confirmed that the patient’s pneumonia was still present, and he would need new vascular access to treat the infection. The facility contacted Vascular Wellness and requested a nurse clinician to place a PICC line. A short while later, the clinician arrived and reviewed his medical history. The clinician learned from a conversation with the patient that he had several concerns, ranging from the level of procedural pain to the depth and breadth of the clinician’s experience. The patient had experienced numerous painful blood draws due to swelling in his hands, and was apprehensive about another procedure. The clinician answered each question with patience and kindness, ensuring the patient was comfortable with how the vascular access would be performed, why it was necessary, and that his comfort level with her and the procedure was an integral part of his treatment. Once the patient was comfortable, the Vascular Wellness clinician began the process. Vascular Wellness clinicians use ultrasound guidance and other advanced technology and best practices, and because of this, in addition to the deep skill level of the clinician, she noticed an episode of atrial fibrillation during the procedure. The PICC was placed without incident, and the Vascular Wellness clinician immediately notified the patient’s physician and care team of the Atrial Fibrillation. The medical team quickly ordered additional antibiotic therapy. The patient’s condition quickly improved, and he was discharged the following week.