I have read many of the comments on INR and placing PICC's. I do agree it's a safe way to get central line access with elevated INR. I am wondering if there is any information on outpatients and INR's. Would it be best practise to place a PICC in a patient with an elevated INR and send them on there way? In house at least we are monitoring these PICC sites. Also it seems checking INR's on all outpatients when they may not be on any medications that would alter their INR maybe just adding to medical costs. What are your facilities doing?
Thank you Kathy
It is important to do an assessment on outpatients that would include a medication list. If they are on any medications that would impact their bleeding time, you may want to have them hold the medication pre insertion, if you can get an MD order to do so. If they are already there for the PICC, the minimum education should include to have the patient and family monitor the site for bleeding and give them instructons on what to do if the site is bleeding.
You may also want to consider the standard use of a clotting dressing (such as Statseal) for those outpatients on medications that impact bleeding time.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
As Chris said, assess all meds first. If there is any indication for coag lab valves, you can check the most recent data. If you suspect a problem, you can request a repeat set of applicable coags values. There is no need for this extra lab work if there are no anticoagulant meds or any reason to suspect excessive bleeding. Presence of an anticoagulant med does not automatically indicate that there is a risk of bleeding with a PICC insertion. Surgical CVAD insertion might be different. And other jugular/subclavian sites with excessive probing, no ultrasound etc would increase the risk. So this is a technique related risk. 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