For years we have had as part of our work instruction to apply a warm k-pad to newly inserted PICC sites. The thought behind it is to facilitate vein dilation during initial contact with the PICC to decrease risk of thrombus. At a recent staff meeting we discussed whether or not this is best practice and most of all, where it came from. We have done this since before ultrasound use. Is there any evidence to support the practice and if so, does it apply today when we are using larger veins, visualizing their size on ultrasound, etc.? Was there ever any evidence to support it? The folks that initially instituted this are no longer on our team due to retirement, etc. Thank you for any input you may have in directing me to any studies or otherwise that may expedite our question.
Application of heat after every PICC insertion is not required. This practice was started when PICCs were first stated in the 1970's to early 1980's. Insertion sites were in the ACF as this was long before US availablity. Some hospitals routinely use it for every PICC but others (my hospital) only used it for those that developed what was know then as "early stage mechanical phlebitis". My hospital collected data on our usage and found that only a few patients developed this phlebitis so it was not cost effective to treat all patients. And the IV team was doing all routine assessments every 2 hours so we were catching these events very early and beginning heat very fast. So our track record for complete resolution was great. Now with larger veins for insertion and out of the area of joint flexion and attention to smaller size catheters for the vein diameter, it is not required. In fact, it was never a standard of practice to apply for all patients. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you so very much for your reply! Much appreciated! :)