Hello all,
Have an ICU pt with existing right upper arm PICC that was placed in April. MD suspects line infection and requests PICC exchange. Of note, has DVT of left axillary vein and left IJ. Recent doppler shows new acute DVT of right axillary and right IJ. Informed MD that cannot exchange line with existing DVT. PICC exchange order cancelled but next day ordered again with the comment that the attending MD says it's ok to exchange PICC with exisiting DVT. PICC team MD director gets involved. He asks for evidence to show why it would NOT be acceptable to exhcange PICC with an existing DVT. Have been placing PICC's for 15 years and it's always been my practice not to place line with DVT. I'm surprised MD says it acceptable. Is this something new. Any help is greatly appreciated. Thank you.
We would'nt exchange a line the is suspected of being a source of infection in the first place. It would have to be a new stick. Also, we would not place a PICC in or through a vessel with a known thrombus. There is no evidence that I am aware of because it seems common sense right. A vessel is at least partially blocked with a clot; passing a catheter is going to contact and quite possibly embolize the clot. If the sublavian and EJs veins are available, since they are free of occlusion/thrombus, then thoose would be preferred sites of access.
A list of contraindictions for placement is available by every manufactorer's insert and every vascular access organization on the planet. Suspected or confirmed DVT is and has always been one of them. If your attending physicians believe that's ok perhaps your Medicine Committee should be informed so that peers get an opportunity to comment. Sounds dangerous to me. Of course you could suggest he/she place it in the DVT themselves. That should yeild an interesting comment. I have and will continue to refuse to place PICC's under those circumstances. Interventional Radiologist backs me up 100%. Case closed.