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JudyThompson
DVT in Basilic - PICC in Place

Good Morning all,

I have a 80+ y/o female, A&0x3, s/p knee replacement (infected), get a PICC about about three weeks ago.  Re-admitted for SOB.  CT showed a PE.  Doppler of lower extemities was clean, doppler of basilic showed a DVT without ettensnion (at PICC site).  Pt is non-symptomatic. no swelling, no tenderness, no redness.  If not for the PE and later diagnostics, we'd have no clue she had the DVT.  Her INR is therapeutic, she's ready to go home for three more weeks of IV ABX.  Now my question:  Do I move the PICC over to the other arm? Or since she is not symptomatic and we are keeping her INR therapeutic, do I leave the PICC where it is?  With all the info at AVA about thrombus rates, my initial thought is to leave it be, and have family and clinic monitor.  I suggested doppler studies at two week intervals but radiology shot me down, saying there was no data to support that practice.

 

Thanks in advance

Judy T,

San Diego

 

 

lynncrni
There are no published
There are no published guidelines on the management of catheter-related thrombosis. Most CRT is clinically silent - no signs and symptoms of anything. I think I would leave the current PICC alone and continue treatment. Putting in a new PICC will lead to a new vein bring irritated and possible a new thrombosis. I am also not aware of any data to support repeated US studies to check on the presence of new or existing thrombus, but do not think there would be any clinical harm, just additional cost. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

cathie
we leave them in...unless
we leave them in...unless they exhibit s/s of complications(no blood return, swelling...)..no good reason to compromise the other arm
afruitloop
In my previous position as a

In my previous position as a PICC Nurse of a large teaching hospital, we encountered this also.  We never had a PE from it, but did have documented PICC entry site thrombosis.   

A great question..... what to do with a documented entry site thrombus, but no extension.  As Lynn stated, you will probalby not find anything writen about what to do.  At my facility what we did was nothing more than heat, rest, elevation. etc.  We did look at risk factors for extension of the thrombus when deciding the course of action.  Rarely did we place the patient on anticoagulants for only an upper extremity clot.  More times than not, we were OK with this decision.

 Your patient is on Lovenox, etc to treat the PE (which would also benefit the PICC entry site thrombus) and yes, sticking another site woudl cause intimal damage in a new spot. Home health will be following the patient, with detailed arm assessments, etc. 

 As far as dopplers to FU on extension of the thrombus.  With the patient on an fully anticoauglated dose of Coumadin, or what ever, it is doubtful that the clot will extend.  In our hospital the PICC team would "stop by and take a look" with our Ultrasound to see how the clot is doing.  Of course, the PICC team cannot documented thrombus, but for an "unofficial" look at the vein, we certainly could determine if there is blood flow around the PICC or not.

Good luck!

Cheryl Kelley RN BSN, VA-BC

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