I am just looking to see what others are doing when a patient develops a thrombus in a picc arm. Looking for information on both occlusive and non-occlusive DVT. We are having differences of opinion between doctors on whether to pull the line or not. Thanks.
I am reading an interesting article about this right now.
http://home.smh.com/sections/services-procedures/medlib/education/podcasts/documents/maimd_12-11-09.pdf
For a DVT with a functioning catheter (infusion/injection without resistance and a normal blood return), leave it in and anticoagulate the patient. For a DVT that has totally occluded the blood flow through the vein, catheter-directed thrombolysis in radiology is probably indicated to reestablish blood flow through the area and relieve the severe congestion, pain, and prevent risk of other tissue damage from total obstruction of venous return. If the catheter is functioning, it is probably better to leave it in place. The risk of removing and inserting a new catheter in another vein will probably result in a similar DVT in the new vein. American College of Chest Physicians make this recommendation "In upper extremity DVT associated with a central venous catheter: Suggestion is to not remove the catheter if it is functional and there is an ongoing need for the catheter. Anticoagulation should be given as long as the catheter is in place. If the catheter is removed, anticoagulation should continue for 3 months thereafter." I think the most recent version of this is published in CHEST Journal from 2011, but don't have the full reference. 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