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MARIAJ
PICC related DVTs

A doctor at our facility told us that we should not consider thrombuses in the Basilic and Cephalic vein as DVT since these veins are superficial.  Only DVTs in the Brachial vein need to be considered when looking at data for studies of DVT related to PICCs.

I thought I had read something about this, but I cannot, try as I might, remember where.  Can anyone help me with this?  If you know of an article about it, please give me the title so I can copy it and share it at work with co-workers who are also interested.

Thank you.

Maria 

lynncrni
Just look at the anatomy

Just look at the anatomy literature. The basilic vein is a superficial vein in the forearm, however it becomes a deep vein slightly above the antecubital fossa. Are you using US and MST for insertion in the middle of the upper arm? If so, you are accessing the basilic vein after it have become a deep vein. So this would be a DVT. If you are still using the old techniques at the AC, then the basilic is still a superficial vein. The cephalic vein is a superfical vein throughout the entire extremity, becoming a deep vein in the infraclavicular fossa of the shoulder. But again it does become a deep vein at this point and then connects with the axillary vein.  So a clot in the arm in the cephalic vein would not be a DVT. It is also important to remember that there are perforating veins - veins that connect the superficial with the deep veins. So a problem in a superficial vein could lead to a problem in a deep vein.

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

afruitloop
I have been doing some

I have been doing some research recently for a presentaion in Columbus this week which includes this particular subject.  When reviewing my sources, the basilic is most often considered a superficail vein, while the brachial is a deep vein, mainly becasuse it is contained in supporting structures deep in the arm.  The basilic, on the other hand is not surrounded by supporting structures, thus superficial veins have more smooth muscle that deep veins.

When the basilic and brachial join to form the axillary vein, there is a pretty significant valve there.  Sometimes this occurs in the armpit, but sometimes it occurs anywhere from 3 to 8 cm (in my experience) before the armpit. 

So if your thrombosis was indeed contained in only the basilic, I would think that you have a superficial thrombosis.  If the clot initiated in the basilic but then extended into the brachial and axillary veins, I would summarize that you have a DVT.  During my many years of clinical practice, when obtaining dopplers for UEDVT, the US tech knew the questions we needed answered were:

          1)  Where is the clot?

          2)  Does it extend into the axillary

          3)  Is it occlusive or not?

THese things were critical for my team to know before contacting the phsyician and determining the appropriate care for the complication.

I hope this helps.  Good luck!

Cheryl Kelley RN BSN, VA-BC

amaguila2009
Cheryl, I would like

Cheryl,

I would like to know what your source of information is re: the basilic vein as a superficial vein. I've been thinking about this issue a lot and the potential long-term effects that we create with the PICCs that were placed. Please send me some information so I can bring it up to our next vascular access committee meeting. Thanks.

 

Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]

lynncrni
This is found in the basic

This is found in the basic anatomy. The basilic vein is a superficial vein in the forearm, antecubital fossa and for a short distance above the AC. Slightly above the AC, the basilic vein dives beneath the muscle to become a deep vein, running in the same protective sheath as the paired brachial veins, brachial artery and median nerve. Grant's Atlas of Anatomy, Grey's Anatomy or the anatomy chapter in the INS textbook will have this information. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

MARIAJ
Thank you all for your

Thank you all for your input.  I spoke with the doctor and brought up a few of my questions.  I mentioned the fact that the Basilic becomes a deep vein above the AC, and also that most times, the Basilic and Brachial vein are at the same depth when viewed with the US machine.  Oh, by the way, we use US and MST.

He specified that he probably should not have used the word "superficial", but that he felt that any occlusion AT or PAST the Axillary vein should be treated and therefore classified as a DVT.

Thank you all again.....We decided to bring up the subject, again, at our next Vascular Access Committee.

Maria

sesymons
Whether  the basilic is a
Whether  the basilic is a deep vein or not, our stats should be monitoring the rate of thrombus formation, dont you think?  If we don't consider thrombus formation in the basilic (which is usually the first choice, thereby the highest percentage of picc placement) our thrombus data would be quite scewed.  OR maybe I have the whole point of this thread wrong.  Is the point here to consider when to treat the patient? We treat basilic clots in many cases.
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