At what point, when a patient has altered clotting times, do you apply a pressure dressing to a PICC insertion site? Our problem is that as an outsourced service, the consultant places the PICC, but then leaves the facility. Observation of the site by the staff of the facility is often not done as frequently as we would like, meaning that a hematoma or bleeding can start without being picked up by the staff of the facility.
We have observed on several occasions that the site can be without bleeding for up to 10-30 minutes, lulling the consultant into a false sense of security, but when the venospasm subsides, the site can commence to bleed freely. Does anybody have any guidelines for application of a pressure dressing they can share with me? It would be very appreciated
Dianne Sim
CEO IV Assist, Inc.
I don't have any guidelines to share, however this is a critical problem that needs addressing and am eager to see what others say. Hematoma that is unrecognized can easily lead to compartment syndrome. In this case, you have 6 hours to get that patient to surgery for fasciotomy before there is a signfiicant risk of amputation of the extremity. Even if there is not a compartment syndrome, there is a huge risk of nerve damage. The brachial veins are enclosed inside a protective sheath that also contains nerves and the brachial artery. I have had a legal case that involved compartment syndrome from a hematoma that produced nerve injury that lead to complex regional pain syndrome. Please share your practices. 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
Have you tried this product? I was impressed with how it worked with the oozing cases especially patients with elevated INR. They will send you samples to try. They are developing a disk to make it easier to apply. I have no affiliation with any mfg.
http://statseal.com/
One other thing I just thought of is to always prevent the "double-wall" technique where the introducer needle is advanced through the upper vein wall, lumen, and back wall of the vein; then retracted until it is again in the lumen. This creates a great way for hematorma and bleeding. There are now several products to control bleeding at the insertion site - they are intended to prevent bleeding from the puncture site. I don't think they would have any impact on an internal hematoma though. 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
opps, yes, I am sorry, just for surface oozing. I did not specify...