Q. What is your professional opinion of placing a picc line in an active IVDU patient that has ” track marks”; that start at the a/c and extend up to the upper arm, close to the axilla.
Vessels on examination appear patent. Should one go ahead and insert the picc line. I personally would like to get a venogram done to check the patency of the vessel and consult with a vascular surgeon.
Physicians not keen on placing a CVC. Pt has an IJ, however needs venous access for 6 weeks and is on vancomycin.
Concern: same principles would apply as, scar tissue, inflamed skin or keloid tissue. One would not go through it to access the vein. Track marks already indicate a chemical and physical change to the vessel.
A. As you indicated there are multiple issues associated with IVDU. The first, and most important in my opinion is the opportunity to use the vascular access device inappropriately. There are devices now that can lock the end port and only be opened by nurses performing the infusion.
The second issue you mentioned regarding scar tissue and changes within vessels is not unlike a cancer patient who has received chemotherapy. As with any treatment a risk benefit determination is made to assist the decision for selection of the best device for the patient. The choice of peripherally inserted versus chest inserted catheter, again, is based on that risk benefit analysis.
I know when I spent time at a Hospital I saw their process for contracting with IVDU to receive therapy and agreement to have drug testing weekly or as determined. The patient would continue to receive the treatment as long as they were clean with each drug test.
There is no easy method for the safe provision of intravenous treatment for an IVDU. The decision for insertion and therapy within or outside a hospital for 6 weeks requires consultation with medical providers and clinicians involved with the case to settle on the best approach for the patient.
Nancy Moureau, RN, PhD, CRNI, CPUI, VA-BC and CEO of PICC Excellence, Inc. Hartwell GA USA