Can you point me to recent literature about removing a picc when the patient has an upper extremity dvt? Specifically, anticoagulate the patient and then when is it "safe" to pull the line?
My other question is about the # of lumens. Now that we have the 5fr triple available, the nursing staff really want that triple! I have explained the risk for infection related to hub manipulation and avoiding idle lines. Please add to the discussion for the "smallest length and gauge and the fewest number of lumens".
Thank you!
Current literature actually says NOT to pull the PICC, but leave it in and anticoagulate the patient, until therapy is completed. The rational is that once a vein is "trashed" with a DVT, the patient has a significantly higher risk of developing another one, so putting a PICC in another vein could set the patient up for a second DVT. Use the catheter if it is working, pull it as soon as the patient can get by on peripheral medications. This was presented by Dr. Tom Vessley at AVA in 2011, I believe, and there was an article published in CHEST.
Regarding the INS STANDARDS of using the smallest line, smallest number of lumens, it is a standard, and there are many citations after that standard to back it up. Smaller lines mean less risk to the patient, less risk of DVT, infection and other complications. Many floor nurses do not realize this, they just need a short lesson on the risks.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Thanks for your response. I'll look for the CHEST article. The discussion with the nurse was how long to leave the line once the thrombus is discovered and anticoag agent initiated. If the patient is switched to po meds the next day is it safe to pull the line? wait a couple days? a week? Maybe there are no absolutes and this is something that requires more investigation?
Like I said, the new 5fr triple threw me a curve ball when trying to explain the smallest line with the fewest lumens. They're just not buying the fewest lumens part. I'll do some more digging in the standards. Thank you!
Hello Jill. Were you able to locate the study. If not I'm pretty sure I have it. Email me at [email protected] and I'll send it if I can locate it.
Hi Jill,
Here's another reference pertaining to UE DVT management:
N Engl J Med 364:9 NEJM.org March 3, 2011 ppg 861-869
I also have the CHEST article. Email me & I will forward it to you.
DB
David Bruce RN
The assessment of the inserter must include the number and types of infusion therapy and the anticipated length or changes in that therapy based on primary and secondary diagnoses known at the time of insertion. If multiple lumens are not indicated that they should not be used. Triple lumens are a larger size so you can add thrombosis to your list of potential complications. If you are talking about an ICU patient with multiple drips and meds, it might be indicated. But for hydration and antibiotics, it is not indicated unless you anticipate changing to parenteral nutrition or other continuous infusions to be needed at a later date. 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
What would be the next best action if a patient has a DVT in picc arm but is unable to be anticoagulated due to low platelets? (being treated for leukemia)
Patient has received blood products, platelets, FFPs but platelets remain low. Patient bled at site for days with initial picc insertion.
Should the picc line be removed?
Jean -
Does the patient still require IV therapy requiring central access? Is this a symptomatic DVT? Multiple peripheral veinpunctures (PIVs / labs) will also increase activation of the clotting cascade, so I think it is a risk/benefit question. Which holds less risk and the most benefit for the patient?
Keely
Keely Ralston RN-BC, VA-BC, CPUI, RCIS
I agree with Keely - risk vs benefit for that specific patient. 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
Hi
We have had a lot of success with our products keeping the lines and caps off of the skin and caps tucked away nicely while not being accessed. When our daughter was sick and needed a PICC and Central (Broviac) the nurses told us to do our best to keep the lines and caps clean and off the skin as much as possible, as well as try not to let the caps drag onto external objects. Not sure if our Wrap or Sleeve will help but we are willing to send you some free samples to try on your patients.
Let us know. You can contact us through our website.
www.carealine.com
Mike