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Laura Cordell
Catheter-related venous thrombosis

 83 y/o female with hx of stroke, a fib, CA of kidneys admitted with GI bleed.  PICC placed.  develops sx. of a thrombosis. Duplex shows a clot surrounding the catheter from the entrance site to as far as the study could visualize. DI reads it as a larger than usual clot. There is blood flow around it. PICC ordered discontinued.  PICC team reluctant, asked a radiologist to pull under floro.  Radiologist refuses unless patient is anticoagulated.  Pt. cannot be anticoagulated. Patient's MD and radilogist tell PICC nurse to pull.  As the clinician for this group, I said if an MD won't pull it, then nursing should not either. We know it needs to come out, we just feel an MD should do it or be present in case the clot sloughs off.  INS policies/procedures say to initiate anticoagulant therapy or thrombolytic therapy as ordered, it does not say if a nurse or physcian should pull it. We went up the chain of command and the end result was it was discontinued by a picc nurse with a physcian present in the room.  Dr. Mosley could not find any information that this was particularly dangerous.  He would like to know what others are doing. Who pulls the line, any particular increase in short term monitoring.

 

 

lynncrni
Several years ago, I

Several years ago, I addressed this issue in a Q&A column in JVAD. You can find that column on my website at www.hadawayassociates.com, click on Clinical Articles and look for the one titled - Risk of Pulmonary Embolus with Catheter Removal. This is a couple of years old, so there could be new info that I am not aware of. I would strongly advise all hospitals to have documented competency on all nurses removing any form of CVC. This is an issue that is frequently brought up in lawsuits.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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