Michael Anstett who is an independent PICC contractor in Florida did a wonderful presentation at AVA in a break-out session. He followed 100 PICC lines placed in skilled care patients for thrombosis after power injections for four weeks with doppler at week 2 and week 4. He found a zero percent thrombosis rate in 100 patients with a Medcomp reverse taper PICC line
He did not do pre-scans which would have been nice to say the vessels were clean prior to the insertions as well. The vessels on doppler were clean post-scan. He is publishing his results in the AVA journal.Â
There is a tape to buy and his slides are on the AVA website if I am not mistaken from the program he gave.
We need more RN's publishing as Anstett's presentation is still considered anecdotal without a paper behind it. Unlike any papers published on thrombosis the catheters he placed were not midclavicular, with no x-ray, and were placed with ultrasound and micro's. The majority of papers with RN results are so old that they have no new technology or PICC tips placed in the lower one third of the SVC and are therefore irrelevant. The Grove study that seems to be the pinnacle study for some even shows that RN's have a higher thrombosis rate for the 5 French  PICC line as a result of using old technology. The RN thrombosis rate on the 5 French was >10% versus doctors a little over 5%.
It would be nice to have studies where the date was collected in the decade of 2000 and not in the 1990's. Even the famous Maki chest article on PICC lines have a high infection rate has data in it collected from the 1990's but not published until 2005.
Kathy Kokotis
Bard Access systems
Cindy Schrum RN CRNI
I would encourage every clinician to do as Michael has done and look at your catheters post-insertion with a doppler to assess flow. If a problem is detected, early intervention by increasing blood flow around the catheter could mean the difference between a superficial vs a deep vein thrombus for your patient. This will also help to determine if the catheter/vessel ratio is being assessed appropriately.
Post insertion assessment for vessel patency should be a part of catheter care. A silent thrombus still has the potential to cause harm. Prevention is the best treatment.
Cindy Schrum RN CRNI
Something to note in the presentation was that a large number (55%) of these Nursing home patients were on some type of anti-coagulant. Interestiing that the studies were done at week 1 and week 4 but nothing on the PICCs that were discontinued. Would have liked to have seen the studies on those for comparison. 70% of the lines were removed prior to the week 4 study, would have been nice to see dopplar on those arms prior to removal.
Kathy is correct that more studies would be nice, unfortunately research money is hard to get sometimes. Nurses should absolutely use the tools they have to continue to assess the patient's arm for the silent thrombosis that can occur.
Studies that are considered Landmark studies are just that until another that matches is done regardless of their age.
We as nurses need to be vigilent in doing the right things for our patients in assessing them for the right device (it is NOT always a PICC) for the right patient at the right time. Only then can we truly do our best to preserve the patients vessel health for future use.
Laurie Rasberry, RN, CRNI, OCN
Vascular Access Clinical Specialist