This is an old protocol that came from the early days of AC insertions. There was an increased incidence of thrombosis and early stage mechanical phlebitis with insertion directly in the AC. When US became the dominate method for insertion, sites moved up the arm and out of the AC. Thrombosis rates are lower when the insertion is out of the bend of the arm. So if you are inserting in the mid-upper arm with US, there should be no need for this prophylactic treatment with heat. Many years ago, my hospital published our outcomes. We found that we did not need to treat all patients prophylactically because our rates of early stage mechanical phlebitis was so low. We only treated with heat when signs and symptoms indicated the need for it. Lynn
Our post PICC insertion Nursing guidelines include:
(1) Cold pack the first 24 hours PRN--If the insertion was at all difficult e.g. required more than one venipuncture--The cold will help control bleeding/bruising
(2) Heat application PRN patient comfort--Sometimes it relieves shoulder joint achiness particularly in the older patient
Phlebitis is not an issue because all our PICCs are placed in the upper arm and we very rarely use the Cephalic vein which is more prone to this complication
Robbin George RN Vascular Access Resource Department Alexandria Hospital Virginia
a few years ago. There is evidence to show that heat can reduce inflammation, so we'll (ask for order to) use heat, and NSAIDS if not contraindicated, for early signs of phlebitis in patients for whom there is benefit of keeping the PICC line in situ. Otherwise, it was a waste of time - and money if using the thermapacs. As Lynn said, now that we are traumatizing the vein much less with skilled PICC nurses using U/S guidance and MST we don't see much phlebitis. When we do, it is usually in a higher risk patient (inflammatory type states like crohns, RA, CA, lupus, etc.).
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
This is an old protocol that came from the early days of AC insertions. There was an increased incidence of thrombosis and early stage mechanical phlebitis with insertion directly in the AC. When US became the dominate method for insertion, sites moved up the arm and out of the AC. Thrombosis rates are lower when the insertion is out of the bend of the arm. So if you are inserting in the mid-upper arm with US, there should be no need for this prophylactic treatment with heat. Many years ago, my hospital published our outcomes. We found that we did not need to treat all patients prophylactically because our rates of early stage mechanical phlebitis was so low. We only treated with heat when signs and symptoms indicated the need for it. 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
Our post PICC insertion Nursing guidelines include:
(1) Cold pack the first 24 hours PRN--If the insertion was at all difficult e.g. required more than one venipuncture--The cold will help control bleeding/bruising
(2) Heat application PRN patient comfort--Sometimes it relieves shoulder joint achiness particularly in the older patient
Phlebitis is not an issue because all our PICCs are placed in the upper arm and we very rarely use the Cephalic vein which is more prone to this complication
Robbin George RN Vascular Access Resource Department Alexandria Hospital Virginia
Robbin George RN VA-BC
a few years ago. There is evidence to show that heat can reduce inflammation, so we'll (ask for order to) use heat, and NSAIDS if not contraindicated, for early signs of phlebitis in patients for whom there is benefit of keeping the PICC line in situ. Otherwise, it was a waste of time - and money if using the thermapacs. As Lynn said, now that we are traumatizing the vein much less with skilled PICC nurses using U/S guidance and MST we don't see much phlebitis. When we do, it is usually in a higher risk patient (inflammatory type states like crohns, RA, CA, lupus, etc.).
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center