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coags and bedside picc insertions

I have been a picc line nurse for many years. We have put in many picc lines at the bedside with abnormal coags because we are told its the safest procedure....which it usually is.
This is what I don't understand..... If the IR MD's will not place lines in IR with abnormal coags, under direct fluoroscopy and with emergency supplies, why do we? We do NOT have ANY backup if anything goes wrong. So far nothing ever has.
This issue has again been raised the Chief of our Nursing Service.
Our facility is considering implementing the same parameters as the MD's follow in IR.
I do not know how to respond to our Chief.
Lynn?????? anyone

jill nolte
think about it

 What kind of line would they choose for the patient?  Multiple sticks for peripherals?  A central line in the IJ?  Heck no!  We used to make a nick for pretty much every PICC placement, in those days coags might have mattered more.  Now a nick is rarely necessary, and even if the patient does bleed we can apply pressure, Stat Seal is handy and affordable, Guardiva helps with oozing, I've forgotten all the other options but high coags are not a reason to avoid placing a picc.  I would say your Chief needs some updated information, and maybe IR does as well.

mary4278's picture
 There is a low risk of

 There is a low risk of bleeding, It is easily detected and controllable should it occur. I still will perform a chart review,look at all the labs and have a good sense if the patient is at risk for bleeding. You can compress an arm should you have any bleeding complications. 

I agree with Jill. In the

I agree with Jill. In the earlier years it used to be a criteria to have INR below 1.5. But much has been written and that is no longer an exception. IR may be thinking that they are going into a larger vessel (subclavian or IJ) so they may have stricter protocol.

I have pretty much taken INR off the table at the bedside, and with great results. However, I would say if you find yourself with a "pin the tale on the donkey" type case. I would certainly give it more thought.



 You must make sure that you

 You must make sure that you are comparing apples and oranges. IR inserts many different types of CVADs. So a "line" to them is very different from what you are placing at the bedside. Is IR policy actually based on insertion of CVADs that require a surgical insertion procedure such as implanted ports or tunneled cuffed catheters? Do they simply apply practices oriented toward those CVADs to PICCs insertion that is much less of a risk? You have to get all these details first to actually educate your CNO about the specific risk for insertion of each type of CVAD. PICC insertion does not carry the same risk as other CVADs for venous air embolism either. So each type of CVAD must be considered separately. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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