Has any one encountered a clot in the pt's PICC arm that didn't have other symptoms? Just curious because the EC and PI nurses in our home health want me to change our policy that states an increase in arm circumference of 2CM needs to be reported to the physician. The nurses are not following this so they want me to add "and having pain or other symptomes of a clot". I have had one pt in 3 years develop a clot and there was some pain as well as the increase. I am quite frankly not real comfortable with changing this. Any feedback is much appreciated.
Valorie Dunn, RN, BSN, CRNI
Infusion Therapy Coordinator
Home Health Pharmacy
St. Elizabeth Regional Health
The vast majority of catheter related vein thrombosis is clinically silent. It is present but there are no signs or symptoms. So when you do have any of these, they should be reported to the physician. An increase in arm circumference above the baseline measurement is an indication of obstruction to venous return. The list also includes pain in the arm, neck, jaw, ear, eyes, headache. Also engored peripheral veins on the arm or chest, difficulty moving the neck, or arm. When any clinical sign or symptom is present, it should be reported to the physician as the clots presence can increase the risk of pulmonary embolism. Most of the time, catheters are no removed but the physician may want to add some type of systemic anticoagulant or try catheter directed thrombolysis. Catheter removal is not always indicated as insertion of the new catheter can lead to the same outcome. But yes, I would put it in the p&p. 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
Thanks Lynn. I don't want to change the notification for arm circumference increase to "increase AND other symptoms" because I suspected other symptoms my not appear or if they are not very bad, it get ignored. And I don't feel noncompliance by the nurses is a reason to change a policy that in the long run could be a detriment to the pt. The nurses are just going to have to follow the policy. Thanks again!
Valorie Dunn, RN, BSN, CRNI
Infusion Therapy Coordinator
Home Health Pharmacy
St. Elizabeth Regional Health
Valorie Dunn,BSN, RN, CRNI, PLNC