Our hospitalists feel that they are seeing an increase in DVTs at our facility. We place about 1000 piccs a year and have 10 trained RNs placing them. Two questions:
1. What would the expected number of DVTs per piccs placed be?
2. What Diagnosis is known to increase the risk of DVT?
Thank you,
Laura Cordell
What product are you using? Have you made changes in the product recently or added new staff members? There are many reasons patients can develop upper exgtremity DVT.....some are preventable while some are not. I did a presentation at AVA a couple of years ago on this subject. I also recorded a video on the First, Do No Harm webiste that you may find helpful when selecting patients for PICC appropriatness. It is at www.firstdonoharm.com If you have further questions, please let me know.
Cheryl Kelley
Clin. Specialist, Teleflex Medical
Cheryl Kelley RN BSN, VA-BC
Cheryl,
We are using Bard products and we quickly became aware that the new 6 Fr. triple lumens increased the risk of DVTs. We have since gone to the 5 Fr. unless the patient's veins can support a 6 Fr. We have also added several new team members and we are considering both of these as potential causes. We place about 1000 piccs a year and Coding has pulled out 10 DVTs which is why I was interested in the expected number of DVTs per line days.
Question, are you putting K-units or hot packs on your piccs after placement?
Thanks,
Laura
Laura Cordell, RN, CMSRN
Resource Unit Clinician
CNA Educator
We are doing a retrospective study of symptomatic DVTs with PICCs. Of course, this study hasn't been concluded. We are a multi-hospital network of hospitals and are looking at one site's population. During the study period, we inserted over 2300 PICCs at that one site. Our DVT rate is less than 2% of that and not expressed in 1000 catheter line days at this time. We hope to have a info to share that helps us all.
From my experience, we see increased DVT with oncology patients the most.
Gwen Irwin
Austin, Texas
Gwen,
Thank you. I have another question. Do you place K-units (dry hot packs) on your piccs after insertion?
Laura Cordell, RN, CMSRN
Resource Unit Clinician
CNA Educator
We evaluate the vein size to determine if the vein can accommodate the the size of the catheter without a tourniquet. We want the vein to be more at least than 2 x times the size of the catheter, but really want it to be more than 3 times the size of the PICC. We don't apply any heat to the site.
Hope this helps.
Gwen Irwin
In 2009 we placed over 1000 PICCs with a DVT rate below 2%. WE are an LTAC with extrememly sick patients. All with multiple systems failures including PVD, multiple previous line insertions. We accurately measure the vein size prior to insertion and will NOT place a PICC unless the vein is adequate to support placement. There are numerous other factors to be considered. Most were mentioned by others on this blog. I don't believe there is any accurate data representing an expected number of DVT's /Picc placed.
What about this scenerio? The PICC line is inserted into vessel of adequate size without difficulty. PICC line inserted for 6 weeks antibiotics at home. Pt readmitted to hospital and put on a pressor infusion- i.e. Levophed, Neo, Dopamine. So now pt has some peripheral vasoconstriction. Pt not septic so PICC line remains in place. Pt on pressor for a couple days via PICC line and then develops acute onset of arm edema on side of PICC line. I would think the use of pressors would increase the risk of PICC related DVT regardless of the size of the vessel when line inserted.
Surprisingly this pt's ultrasound/doppler study was read as "pseudo obstruction" of basilic and axillary veins.
Juline DiSilvestro BSN, RN, CRNI, VA-BC, CPUI
Central Access Team Nurse
Inspira Medical Center- Woodbury,NJ
I think this PICC, like most of them, had a fibrin sheath or perhaps even a silent thrombosis on top of this fibrin sheath. This consumed part of the vein lumen. The vasoconstriction from the drugs closed the available space between the vein wall and this fibrin/thrombus producing this pseudoosbstruction. What happened when the pressor were no longer required? Did the vessels return to their normal diamater and blood flow return? Or was this PICC removed due to the edema? 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
PICC remained in place. Close observation and elevation of the arm with heat application. Edema did decrease after a few days but did not completely resolved, levophed was slightly decreased but not much. Pt expired due to other medical problems. I also was interested to see what would happen when Levophed was stopped.
Juline DiSilvestro BSN, RN, CRNI, VA-BC, CPUI
Central Access Team Nurse
Inspira Medical Center- Woodbury,NJ