Mom is 94 years old has lived 14 years after having heart surgery 4 way bypass at age 81...she is in the hospital getting over the flu with congestive heart failure with The pneumonia, bronchitis..she is receiving good care so far..however her hemoglobin has gone from 9.5 to 7.5 in about 8 days from the time she was admitted and her doctor is advising putting in a picc line to receive her antibiotic due to her having to have the IV changed ... the problem they are having is Moms veins are blowing every time they try and now Doctor is wanting so insert picc line. Family just wants to know what the pros and cons are due to her age and she (mom) is getting a little combative but from not understanding why she needs this? Family just wants to do all we can do for our mom we are all 7 children taking turns and helping with her care and would absolutely want the very best for her. What are or could be the complications?
Often in these situations with the very elderly the choice is making the least bad choice. It's no longer clear cut what the best choice is.
Have you asked for a review by a palliative care team, or even the hospice team? Have you asked the hospitalist if s/he would do a picline for her/his own mom?
You are in a tough place. My thoughts are with you.
The procedure is that usually the line is threaded from the IV site (usually brachial vein which is near the inner arm by the elbow). The nurse does a “cut down” meaning under sterile technique she/he must perform a tiny incision to get access to the vein. Then the IV line is threaded up into the patient’s right atrium of the heart. The line is then sutured at the site and a sterile dressing (usually a sterile transparent dressing) so the insert spot can be viewed easily.
Before the line is used an X-ray is performed to assure the line is indeed in the right atrium. Then the line can be used for IV antibiotics long term.
If your mother is able to understand what the line is for and is not combative during the line insert that’s all well and good, but if she fights them during the procedure they won’t insert it.
Elderly people have a tendency to pull out those lines when no one is looking as the person gets confused, gets curious and decides to pull it out. The possibility they can bleed to death is real if left unattended especially if they are on blood thinners of any type & the person doesn’t hold pressure at the site once it comes out.
Another complication is infection from the PICC line if not properly cared for. Chances of infection are high and if a line becomes infected realize it is a central line meaning the tip is in the heart & if infection develops it can lead to sepsis & death.
Another problem can be the line gets occluded and blocked which then requires more manipulation to get it cleared. They can use a special solution that must “dwell “ in the catheter to dissolve the clot. The solution at times doesn’t work & needs to be repeated.
However if your mother is “with it” and calm & cooperative the PICC line is a great option for long term antibiotics.
Realize this line can’t be used for blood administration as the line is too small & blood can clot the line easily. It’s limited to antibiotics and fluid administration if mother gets dehydrated.
I have both had a PICC line myself and taken care of many. It hurt going in with the cut down but never hurt again. Mine worked well. It’s also relativity easy to teach the family or patient to self administer antibiotics at home. Usually a home care nurse comes in weekly to change the dressing and flush the line to see if it works.
Hope this helps.
If it were my mother I would want a sensible summary of what is going on. I am glad that you have confidence in her care team, but all the same you and the family need to understand just how ill she is and get their best, realistic assessment of her prognosis. She is fighting quite a lot there. I wish her and all of you the best.
The only negative to picc line is if proper care is not taken at the time of doing it infection may happen. Now a days hospitals have well trained team to do this and nurses are well trained to avoid infection. Do not worry. Go for her
I wish I had insisted on one. It's a bit more invasive when they put it in, but it will save her from permanent damage to her veins. Save her from s lot of IV sticks and pain. With her combination of serious ilnesses, it might just save her life. They can get more medication and fluids in faster
. No loss of RX is fluids into her arm from infiltration...vein leaking or bursting. Less bruising!