What are your institutions contraindications for PICC's? (ie. lab values, disease processes, etc.) Are these contraindications in your Policy and Procedures for PICC's?
Marty Quinton, RN, BSN, CRNI
PICC Nurse
Methodist Germantown Hospital
Germantown, TN
generally we look at things such as mastectomies with lymph node involvement/removal; existing thrombosis of upper extremity vessels (specifically the basilic or brachial of the upper arm and any extentsion of this thrombosis); known stenosis or occlussion of upper extremity vessels; axillary, subclavian or centrally; vessels that are of inadequate size to accomodate a picc line; severe edema of the extremity; and upper extremity fistulas - these are usually our absolute contraindications. We take into considereation pacemakers, simple mastectomies, simple edema, dialysis patients without a fistula, non-occlusive thrombus of the forearms or cephalic veins, port-a-caths, excessive chest scarring from previous central line placements and the presence of collateral vessels - for these instances we use the opposite extremity if at all possible and the extremity on the side of one of these items only as a last resort and after speaking to pt/family/MD. As far as labs are concerned, we don't have any absolute contraindications - we do like to know coag studies if available and for patients who are being followed by renal or whose eGFR is <60, we will generally speak with nephrology or the physician if nephrology is not following. We also keep a list of our non-picc candidates who are unable to have a picc placed in either extremity so that it saves us time in the future when we receive an order and the patient's name "rings a bell", our list states their name and reason for not being a picc candidate - this has helped tremendously.