What is the general experience out there with leaving PICC lines insitu once the patient has developed a a venous thrombosis in the same vein. After anticoagulation do most people remove them or still use them? Also would you suggest using the PICC still? Any suggestions and comments would be appreciated
Thanks
This was a signficant discussion at AVA last Sept. The presence of venous thrombosis does not mean that the catheter should be removed if the catheter is still functioning. It should be used and the patient managed with the catheter in place. Removing it and inserting another catheter in another vein will only cause 2 sites of thrombosis. 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
Thank you for your reply Lynn. It is most helpful. Do you have any articles or reference sites I could have a look at ?
I have another enquiry
Our guidelines indicate that all CVC's have a dressing done 24 hours post insertion. This is also for IADs.What is your opinion on changing the dressing on a IAd site Q 24 hours after insertion ?
For references, check the new edition of the INS Standards of Practice. They were due to be mailed from Boston last Friday so they should be in the mailbox of members shortly. If not a member you can order them now. There is a new standard on VAD associated thrombosis.
RE changing the dressing within 24 hours. This practice originated from the old method of PICC insertion. This through the introducer technique left a very large hole in the vein and the PICC was smaller than this hole, thus the bleeding in the first 24 hours. If there is no blood due to the insertion procedure, there is no need to change the dressing. Any time the dressing is wet, dirty or nonocclusive the dressing must be changed. If clean, dry, and totally adherent, the dressing can be changed weekly if using a TSM, every 48 hours if using gauze and tape.
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
Thanks for the reply Lynn.
Does the practice of leaving the PICC insitu when a thrombus has been identified apply to all thrombi? Even an occlusive thrombus with excessive swelling of the limb?
It does make sense that the new PICC will cause a new thrombus, however, if the pt is symptomatic and has significant edema and pain......shouldn't it be pulled?
Martha
When you start anticoagulation, you will be surprised at how quickly the edema will begin to disappear. If the edema and pain remains an issue, of course other interventions may be necessary.....new line, etc. As you know, each case must be looked at individuallly, but first, one should consider leaving the line in place.
Cheryl Kelley RN BSN, VA-BC
Dr. Vesley spoke on this very topic and provided attendees literature which included recommendations of leaving the catheter in place if its needed. It was "Clinical Practice Guidelines from American College of Chest Physicians (2008)" Section 8: Upper Extremity Deep Venous Thrombosis.
Sorry, here's the citation:
Kearon C et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2008; 133:454S-545S.