What is the standard for inserting a PICC on a Patient on heparin and/or warfarin? We are currently holding IV heparin for 2 hours prior to PICC insertion. We also have an INR cut off for Warfarin patients. I am just checking to see what others are doing. Recently an MD asked me if I thought it would be safer to have a central line placed in a patient with a high INR. Of course the doctor is right in this case because it would be safer to place a PICC. The patient's INR was over 5 and liver dysfuntion present, so not medically reversible.
Any time there is a risk of bleeding for any reason, a PICC will always be safer because direct pressure can be applied. I have never seen any policies calling for stopping heparin or warfarin prrior to PICC insertion. There is also no study supporting a maximum high lever of INR when a PICC should not be inserted. 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