Establishing Vascular Access for Long-Term Antibiotic Therapy

Case Description

A 72-year-old female with recent diagnosis of osteomyelitis presents to the outpatient infusion clinic to establish vascular access for long-term vancomycin therapy. The learner will evaluate the patient, review medical history, and establish vascular access using the appropriate technique.

Learning Objectives

– Learner understands indications for PICC line placement
a. The learner will have to identify the appropriate vascular access device to use for insertion based on the clinical scenario provided (e.g., PICC vs. midline vs. PIV)

– Learner identifies precautionary conditions that increase the risk for complications during or after PICC placement
a. The learner thoroughly reviews the patient’s medical history to identify medical conditions that may place the patient at risk for PICC-related complications (e.g., chronic kidney disease, coagulopathies, history of mastectomy, thrombosis, chest trauma, presence of central line, etc.)

– Learner demonstrates appropriate anatomical site selection and catheter measurement assessment in preparation for PICC placement
a. The learner scans anatomical sites on the upper arm with ultrasound to identify appropriate veins (basilic, brachial, or cephalic veins)
b. The learner correctly measures length of PICC catheter based on where the PICC will be inserted and where it ends in the distal ⅓ section of the superior vena cava

– Learner performs PICC placement following the correct insertion sequence
a. The learner will have to systematically insert the PICC line per recommended skills checklist

– The learner would be expected to interpret correct PICC placement by reviewing the final chest X-ray

– Learner documents the completion of the vascular access procedure
a. The learner would need to indicate that documentation has been completed