I wanted to ask everyone how they are handling these problems in their facilities.Â
It is my understanding that if a patient has a superficial venous thrombosis or DVT in their upper extremity prior to picc placement, you would avoid placing a line in that extremity. In instances where a picc is in place and a thrombus or DVT is found what are your currenty guidelines?
If non-occlusive or in a vessel not involving the picc directely (i.e. cephalic vein and picc is in the basilic) would you still remove the catheter or treat with LMW and/or coumadin and monitor the extremity.
If occlusive, do you remove immediately or treat with LMW and/or coumadin for a set period of time and then remove?
 In many instances, we are finding that the physician orders for the catheter to be removed and a new one placed in the opposite extremity. We caution them that the presence of a DVT although in the opposite extremity, significantly increases the risk of the patient developing another thrombus/DVT in the extremity of the new picc line. Unfortunately, these patients require venous access and would benefit from a CVAD (teams are hesitant to place a subclavian or IJ due to the infection risks)
I recently came across this study I have attached and would value your input.
Thanks
Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]
Kathy Kokotis
Bard Access Systems
Below are the vascular access guidelines on thrombosis from Society of Interventional Radiology done in 2004. They are the only guidelines on thrombosis to date
Kathy
Kathy Kokotis
Bard Access Systems