Many risk factors for thrombosis and the new PICC will probably develop a thrombus as well. It probably would have been better to try tPA first. Why was the catheter migrating so much?. How was it secured externally? What was being infused through it? How much longer do you anticipate needing a VAD? All of this should be included in your complete assessment. Lynn
Lynn, Thank you very much for responding. The catheter was stat locked. The PICC was 5cm external to correct right atrial placement then migrated two cm with one dressing change and third cm with the second dressing change. I had a second nurse assist with the second dressing change, Those power piccs are stiff and seem to pop out further when cleaning the skin if there is more than 4 or 5 cm external. The picc will be needed for at least another couple of weeks. He just started treatment with Cipro for pseudomonas (trach), IV Ativan and has a two week old phlebitis from a peripheral IV site for which he may get Vancomycin. His new PICC is a 4 fr single lumen, previous was triple, 6fr. In hindsight I should have left the PICC in and tpa -ed as you said. Instead of anticipating more migration, I should have waited until it actually happened and addressed it at that time. I really thought I was doing the right thing at the time and felt good about it. Now I see I should have not been so quick to act.
Many risk factors for thrombosis and the new PICC will probably develop a thrombus as well. It probably would have been better to try tPA first. Why was the catheter migrating so much?. How was it secured externally? What was being infused through it? How much longer do you anticipate needing a VAD? All of this should be included in your complete assessment. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn, Thank you very much for responding. The catheter was stat locked. The PICC was 5cm external to correct right atrial placement then migrated two cm with one dressing change and third cm with the second dressing change. I had a second nurse assist with the second dressing change, Those power piccs are stiff and seem to pop out further when cleaning the skin if there is more than 4 or 5 cm external. The picc will be needed for at least another couple of weeks. He just started treatment with Cipro for pseudomonas (trach), IV Ativan and has a two week old phlebitis from a peripheral IV site for which he may get Vancomycin. His new PICC is a 4 fr single lumen, previous was triple, 6fr. In hindsight I should have left the PICC in and tpa -ed as you said. Instead of anticipating more migration, I should have waited until it actually happened and addressed it at that time. I really thought I was doing the right thing at the time and felt good about it. Now I see I should have not been so quick to act.
Nancy Rose