This is one of those issues that has research and documentation that goes both ways. First and foremost it has to be documentated that it is a non-occlusive thrombus. After that, clinicians can go both ways. Some leave them in, and treat with heparin. Obviously, close monitoring is essential, so that swelling, circulation, etc is not compromised. It may come down to how well the docs trust the nursing staff--is the monitoring of the affected site to be trusted?? Other docs pull out lines at the drop of a hat for any reason just because they are afraid of the liability issues.
All discussion I heard at AVA this year was to leave the catheter in place and treat. Removal and reinsertion in another site just adds to the risk of the same thing occurring in the new site.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
All treatments remain an option based on patient assessment. There are no guidelines that recommend one over the other.
To keep the catheter whilst treating the clot is what our our guidelines say, based on what our coagulation consultant thinks.
Lynn (or anyone else that knows), are there any references supporting this ?
Mats, a pilot trial we participated in concluded: "Treatment of UEDVTs secondary to central catheters in cancer patients with standard dalteparin/warfarin can allow the central line to remain in situ with little risk of line failure or recurrence/extension of the DVT," as published in: Kovacs, M. , Kahn S, Rodger M et al. Journal of Thrombosis & Haemostasis. 5(8):1650-1653, August 2007.
Daphne Broadhurst RNOttawa, Canada
Daphne BroadhurstDesjardins PharmacyOttawa, Canada
Hi, would you be able to send me a copy of this article or email me privately? I have done a search and have come up empty handed. I am doing some investigation as to who needs to remove a picc when there is a documented clot within the vessel with the PICC. thank you for any help you can offer.
I got your article now, will read. Keeping the PICC in place works fine for us. Many times the coagulation consultant is consulted; this works as education for our physicians as well, as keeping the line in situ during thrombolysis can feel a bit scary. Clots stretching to central vessel or progressing clot in spite of thrombolysis means the line gets pulled.
The question that has been raised at our facility - is does it have to be the doctor to remove a line with a documented clot? Is is anyone's practice for the nurse to remove the line in this circumstance? We haven't been successful at finding any literature to support either way.
Thanks if you can help.
Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse[email protected]