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Mats Stromberg
Keeping and using PICC when the vein is thrombosed?

Hi,

had a breast cancer patient receiving FEC chemotherapy who developed a thrombosis in her PICC arm on day 9 after insertion. It went up through subclavia and stopped near the juglar vein. Although asymptomatic for PE, a CT scan was performed and PE was diagnosed. The PICC was kept in place and the patient placed on Fragmin 12500 IE/day. Resolution of symptoms was fast and a month later the thrombosis could not be seen on ultrasound. The line was kept for about 10 weeks and pulled after completion of chemotherapy. If anyone has views on how this was handled, I would be most interested. Do you keep your PICCs when thrombosis occurs?

Although my main question is this: At diagnosis of thrombosis a coagulation consultant was consulted, who said that the PICC line could be kept if Fragmin was started, but it could be not used for the chemoptherapy course a few days after diagnosis of the thrombosis. A PIV had to be placed and used for that course of treatment. The PICC was then used for the remaining three courses. There was never any malfunction of the PICC. Does anyone see the reason in not using the PICC that one treatment?

Mats in Stockholm

lynncrni
I am not aware of any

I am not aware of any published standards or guidelines about prevention or management of catheter related vein thrombosis, but there have been discussions at meetings such as AVA. The consensus I have heard is that the catheter should be left in place and the CRT treated. Removal and reinsertion of another CVC could easily produce the same CRT in another vein. The CVC should produce a good blood return and not produce any resistance to flushing. So the location of the thrombosis would determine if the catheter should be used. If the fibrin/clot is obstructing the lumen, the CVC should not be used. But if you get a blood return and it flushes easily, then treatment for the clot should begin and continue using the catheter. Lynn

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

Mats Stromberg
Thanks Lynn, just my thought,

Thanks Lynn,

just my thought, that as long as it works, the catheter could be used. Inserting a PIV for FEC chemo when there is a functioning CVAD is just exposing the patient to unnecessary risk of extravasation.

Is the consensus that you have heard of anything that can be found online or otherwise, read and referred to?

Anyone else knows of any published guidelines/articles on keeping a PICC in place or not when the vein is thrombosed?

Mats

lynncrni
I am referring to verbal

I am referring to verbal conversations, not anything that has ever been published that I have ever found. Lynn

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

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