It has been brought up that there seems to be an increase in rate of thrombosis in our picc patients. So now i am taking a look at our stats and checking to see what type of catheter used, how many sticks, how many are repositioned, inserter. Any thoughts on what I should be looking at or for? Or how i should be going about addressing this issue? We do use ultrasound.
Sharon Symons
SGH
Are you also looking at the vein diameter when you place the line with US? Do you consider this when choosing the French size of the catheter? Inserter skill level, patient risk factors such as cancer or diabetes, and tip location are all critical factors brought out in other studies. How are the diagnoses of vein thrombosis actually made? Are you conducting these same tests on all patients or only those that are sympotomatic? The majority of all CVCs will have clinically silent vein thromboses. So this must be considered when analyzing your data.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
If you are using a reverse taper catheter, how much of the proximal portion is inserted. Some reverse taper catheters are 1-2 French sizes larger as far down as 8cm. So this means tht the largest part of the catheter is in the smallest part of the vasculature.
You really want to look at your catheter to vessel ratio
Just somethings to consider
In addition to the other posts, I would add that a key word you used is "seems". Even if you were able to locate and tally all of the PICCs in your patients that were symptomatic for thrombus - what data would you compare it to? How many variables would be involved with that data (vein/cath ratio, patient risk factors, inserter skill/#of cannulations, pt. vascular access history, etc.).
Without good studies using pre and post doppler assessments and controlling for variability, length of study time, and sample size - not sure how helpful your data will be.
Thrombosis is a serious issue, and we do need to pay attention to it. And - I wouldn't let anyone "seems" you or your team. Ask them for their data.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Hi Sharon,it's me Patti.....in response to your post, when you stated that it was brought to your attention that there seems to be a rate increase in thrombosis with your PICC patients, I am going to take a different spin on this from my own past experiences with this type of ambiguous statement. I am curious.....who has noticed this.....and is it more than one source as sometimes I have found that a statement may be made that sounds like many numbers are involved where in reality it was really only less than a few or if even that....like 1 patient in reality. Where I used to work we followed every PICC patient post-placement through out the hospital stay so we were able to stay on top of all associated developments so immediately we could come up with answers to statements that were made especially ones that may be exaggerated, etc. So going back and taking an inventory of the items you mentioned is a great place to start along with the other great suggestions given to you on this forum. Also, what catheters are you presently using?.....and have you been able to link to date one catheter that this situation could possibly be connected with if you find there really is an issue at all. It will be interesting to follow how this unfolds for you....good luck.
Kathy Kokotis
Bard Access Systems
lrasberry - who do you work for since leaving BD? Arrow or Angiodynamics
kathy
Kathy Kokotis
Bard Access Systems
Thanks everyone for your responses/advice. I am on it
sharon
Cheryl Kelley RN BSN, VA-BC