1. PICC:
-Indication: med term infusing things (chemo, abx, TPN), or withdrawing things (HD, plasmapharesis)
-CI: coagulopathy, renal failure Cr>3 (need to save peripheral veins for dialysis access grafts/fistulas-- use IJ)
-Complications: infection, thrombus, hit an artery instead of vein and cause hematoma
2. Non-tunneled central lines: uldall, quinton-- temporary, used for urgent dialysis access. IJ/fem/subclavian, avoid subclavian to avoid central vein stenosis
3. Tunneled central lines: hickman, groshong, broviac- have cuff which stimulates tissue growth, keeps line in place. Good for putting things in long term: TPN, antibiotics. Not for dialysis
4. EVDs drain to gravity, set the cmH20 pressure by setting the height of the drain relative to the height of the patient. When placing the shunt, put it in Kocher's point: frontal horn, lateral ventricle
5. For internal shunts: VP shunt first line, VA or V-pleural if you can't get the VP (scarring/adhesions, infection).
6. Axillary lymph node dissection (ALND): 
-Benefits: full axilla dissection, staging, decrease local recurrence which eventually decreases mortality
-Cons: increased morbidity (lymphedema), postop complications (seroma, drain infections, cellulitis)
Sentinel node biopsy lower complications, same survival compared to ALND.
"Available evidence suggests that axillary node dissection is associated with more harm than benefit in women undergoing breast-conserving therapy who do not have palpable, suspicious lymph nodes, who have tumors 3.0 cm or smaller, and who have 3 or fewer positive nodes on sentinel node biopsy" {JAMA review}
7. Melena in an older man (>50) is colon cancer until proven otherwise, particularly with R colon/cecum if there is black, tarry stools. Workup: CBC, iron. Colonoscopy to find the lesion. CXR, LFTs, to rule out mets. CEA too.
8. Biomarkers:
-CEA to detect recurrent colon CA, 30% recurrent cancers are CEA neg-- usually poorly differentiated or if the primary was CEA-
-Octreotide is taken up by neuroendocrine tumors (i.e. carcinoid)
9. Radiation has no role in colon cancer. Chemo may be helpful in bad T2 colon cancers (signet ring, mucous making, +perforation, +venous invasion) and is helpful in T3 cancers. 5FU + leucovorin (not used as rescue as for methotrexate, but rather synergizes with 5FU because it inhibits thymidylate synthase)