Many times with PICC insertion only one arm is available to be used. In these instances what is the amount of time required before a PICC can be reinserted in the arm that formerly had a PICC associated thrombus. Is it necessary to wait 3 months, 1 year, and is a repeat doppler always necessary especially if it has been a length of time. At what length of time would a doppler no longer be necessary? Does anyone have any evidenced-based practice to support a practice?
Thank you,
Denise Shuler
I have no evidence based practice to call upon. However, if this is the situation and we are called to insert a PICC, one of the first things that we would do is assess the vein ourselves. Is it compressible? Is it large enough to accommodate the size of the catheter? We also look for the previous doppler reports to determine the extent (not sure that is the right word) of the previous thrombus. We have had experience with localized thrombus reports (not extending to the axillary or other vessels) that have resolved and have not prevented another PICC insertion.
If there are any assessment components that would indicate the vein is not viable for a PICC, we inform the ordering doctor. If there are any questions after our assessment, we call the ordering doctor.
Gwen Irwin
Austin, Texas
This is only a related story, but my mother was diagnosed with a symptomatic LE DVT in 2/2009. She continues to have intermitant swelling in her foot, and a repeat venous doppler study in 7/2009 showed a still present thrombosis, and they could not determine its age, which means that it has continued to advance at least in some portions. She is an oncology patient. She was on Lovenox then coumadin during this entire period of time, with INRs within range.
What this tells me is there can be no hard and fast rules or guidelines regarding useing a vein or extremity for venous access that was diagnosed previously with a thrombus. Only a repeated venous doppler can tell us to what extent the thrombus has resolved, if any. We need to assess each patient on a case by case basis. We can also assess the veins in the extremety with our Ultrasound. A vein with thrombus will not easily compress completely. If using another vein, you must way the risks and benefits for that patient and discuss with the patients MD. Do they need Central Access? History of a previous or current thrombosis puts the patient at higher risk for a new thrombosis. What are the patients other options?
Chris Cavanaugh, RN, BSN, CRNI, VA-BC