The physicians in our facility have wide ranges of practice for whether or not, and how to treat patients that develop thrombus around thier PICC line. I would like to provide some research to assist and support best practice. What do your facilities and physicians do?
The document to which you are referring has very limited information about upper extremity DVT and did not take a careful assessment of what this means to patients. They almost took a cavalier attitude to this problem as if it were a non-issue in hospitalized patients. They did not address this problem for long-term VAD patients. The studies on prophylactic anticoagulants are conflicting and there is no large, randomized trial that will answer this yet. So I would want to weigh the risk and benefits for each patient.
The original question was about the management of an exiting UE-DVT. No professional organization has taken a look at the collective literature to make any recommendations for its management, that I know of. So we are left with the situation of each physician doing his or her own methods. 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
Hi Lynn,
I'm new to IV-Therapy.net. We're looking for policies/guidelines on the removal and/or treatment a CVC with a symptomic thrombus. As an example, an edematous UE with a PICC and a large thrombus confirmed by x-ray. In this particular case, the MD gave an order for the nurse to remove the line. The nurse called me at home and I advised that the line be removed in IR. The MD agreed. The same situation occurred again about a week later. I've been asked to put a policy in place regarding removal of a CVC that has a know clot-with or without symptoms. Does anyone have such a policy that they would share? Also, we use neutral pressure caps and seem to be noticing an increase in thrombus with the power injectable lines. I've suggested we change to positive pressure caps. Do you agree, if so, can you recommend substantiationing documentation that I can present?
Deb
Could you please elaborate on an increase of thrombus with pressure lines? There are manypressure rated lines out there. What size is the line, is it reverse tapered, or is it a non-tapered line. Also, where is the thrombus located? Is it in the catheter, in the arm, extending to the subclavian, etc. If you elaborate a little more, I can give you the practice that my facility used for the last several years. Lastly, are you sure that the cap you are using is a neutral one? Also, why do you feel there is a relationship between the injection cap or valve and thrombus in the vessel? I'd be glad to help. You can email me off the list if you'd like. [email protected]
Cheryl Kelley RN BSN, VA-BC