I am sure this topic has already been discussed so excuse me if I am repeating.....Does anyone have any research or supporting data on INR/Platelet levels prior to placement of a PICC line. I worked in facilities before that didn't really bother themselves with it but I am in a facility that has certain criteria that blocks the safest line. Any input would be great as I feel like it's the only way I can present it for possibly a change.
Platelets >50
INR> 3.0
I have done a PICC with INR of 7.0 and no problem. I did a PICC tonight on an old IVDA with platelets of 36 and sick. Yes, I cheated. Well, not really....I am not used to looking it up and placed it anyway........don't tell on me........but I felt it was the safest line and he needed blood/FFP. I couldn't have gotten what they require for blood anyway.........and I was much safer than the residents trying the IJ/SCV. Any help would be greatly appreciated.
EJR67
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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
My expereince finds that in many facilities that have "rules" regarding INR and PLT counts have been or are strong radiology placement teams. Thus, the standard for them has been that prior to their procedures (angiograms, biopsy, etc but also including PICC) these lab values are significant.
I encourage the team to think outside the box..... yes, if I am having an arteriogram thru my femoral artery, the significance of a high INR or low plt ct is definitely a red flag. BUT, if I am having a 21g needle stuck into my basilic vein, then it is not as significant. I think the main goal is to develop a relationship with the radiology nurses and physicians and educate them that "not all prodcedures are created equal." A femoral artery stick is definitely in a different category than a basilic vein stick.
When in doubt, always ask yourself this question, "Does the patient truely need central access?" If the answer is yes, then a PICC is the line of choice for central access in a patient with high INR or low PLT.
Cheryl
Cheryl Kelley RN BSN, VA-BC