Does anyone else have an algorithm they follow when there is a venous clot present around a PICC? Who pulls the line if it is occlusive and unchanged after 6 days of anticoagulation? Who pulls the line if occlusive?
We are the IV Team/PICC Team and most of my staff are not comfortable pulling these lines.
Our hospital does have an algorithm and it states: "GUIDELINES FOR DISCONTINUATION OF PICC LINES WHEN VENOUS CLOT PRESENT"
· Clot unchanged
o *Maintain Anticoagulation
o Review with subspecialty (Heme/Onc, Pulmonary, Vascular, IR)
o (nothing about who pulls or what to do after review)
· Clot decreased in size
o *Maintain Anticoagulation
o Pull line (MD present if requested)
Chances are very good that your team has been pulling catheters with thrombosis for a long time. I say this because the majority are clinically silent, yet still very present. You are correct that your protocol should have more information about who pulls these that are unchanged. I don't have a document to share but I think a document should address who and how. The who should be someone that can manage the possible complications. This could include the inability to withdraw the catheter as it is stuck inside the thrombus (may be more likely with an old thrombus due to calcification. It could also include a pulmonary emboli of thrombus or catheter if it breaks. But there could be team members that could be designated to do this with a detailed protocol for management of complications. This would depend upon your professionals available such as hospitalists. The other thing to consider is if this is delegated to physicians, will this mean delays in catheter removal and if so what will that mean for the patient, staff, and hospital. Lots to consider. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Just wondering, what were your references when you developed your algorithm? Thank you.