Is anyone aware of evidence based recommendations regarding placement of PICC catheters in flaccid extremities (secondary to either new stroke or c-spine injury). What if the other extremity is also affected with a DVT, fracture, mastectomy or other clinical reason that would preclude PICC placement ?
Example: XX pt with c-spine injury, 1 flaccid extremity, other fractured extremity and HALO stabilization. No neck access. Requires pressors. Anticipate extended LOS.
Has anyone actively sought a formal PT consult for focused therapy to minimize DVT risk ?
Thoughts ?
Thank you,
Dave B
I can't give you a reference, however this is based in human anatomy and physiology. The muscle pump action is responsible for moving blood in veins back to the heart. Read about this in the A&P chapter of the INS textbook. Paralysis means this pumping action from the muscles is not working, therefore there is a greater risk for stagnation and thrombus formation. I learned this the hard way back in the very early days of PICCs (around 1982) when we placed a PICC in a paralyzed arm of a CVA patient. He had an extensive thrombus along the path of the PICC. 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
This is a perfect situation for an axillary line. You need a longer line (greater than 20cm). The Arrow JACC is coated and comes in a variety of lengths. Bard offers the Hohn - non coated 40cm catheter, and if you do some looking, I'm sure other companies offer longer catheters that are indicated for central access.
Disclosure: I work as a KOL and clinical consultant for Teleflex/Arrow.
Best regards,
Judy