Forum topic

4 posts / 0 new
Last post
DVT risk assessment data for PICCs

It has been suggested that our vascular access team gather risk data r/t DVT formation when placing a PICC and then look for common factors in patients that ultimately develop a DVT.  I would expect to include vein diameter, catheter size, presence of anticoag., number of insertions, hypercoag., and diagnosis.  Am I missing anything? 

Gina Ward
dvt screening



I hand made a pre proc picc line assesment tool;  this just forces me to assess these areas in all patients prior to putting in a picc line, I keep it with my outcome monitor to have available in the event of any untoward event.     


Why PICC line needed

, Reason for admission to hospital/medical history. 

  Lab values.

  Previous line history. 

Risk factors for CLABSI;  did they already have a prolonged hospitalization before picc;  how many days ago were they admitted. 

   Risk factors for DVT;  do they have a prior hx of thrombus, cancer, liver dx, lupus, aids, conn tissue dz, diabetes/renal failure, paralysis/immobility , previous lines.

I also assess and document if the vein compresses well and if the wall was thick or not;  then after case i document.

Then i have  a little note about if no risk for throubus;  may decrease blood lflow my nor more than 50%, if there is a risk for thrombus;  decrease blood flow by no more than 30%.  Then the chart that shows the diameter of the different size catheters and how they relate to vein size and percentage of occlusion of vessel.  ( for reminding/helping me).

AFter insertion;    Then I document the size or approx size of vessel used ( not too accurate with my old site rite, but it is helpful), vessell selected, number of sticks, size of catheter,

Now, this is all just on a 2 sided form, it is my notes, does not go in the chart.  But....after reviewiing and filling out all this info prior to PICC insertion, I am identifying potential risks in advance and am able to make better decisions on type , size and location of device used.   This tool has forced me to assess fully every situation and has brought out patient care issues that many including the physicians have not thought of that has led me and them in a different path regarding type of device, size or even performing a PICC line. 


Hope this helps; 

    P.S.     Regarding DVT.  Why would someone who had a single stick , non traumatic picc line insertion in the basilic vein develop a dvt in the cephalic vein?  Would that warrant line removal?  Do you think this could have developed from a prior peripheral attemtp? 


Thanks,  Gina Ward R.N., CPAN


Gina Ward R.N., VA-BC

Gwen Irwin
DVT risk assessment data for PICCs

There is an article published in JINS that created a risk assessment tool.  I don't have it at home to cite the specific journal.  It includes recent inactivity, ICU patient, etc.  Also, include smoking history.  I will find the reference and post.

As far as a cephalic vein having a DVT when basilic was used for PICC, we have had that happen and investigate to find a history of PIV in the AC.  

Gwen Irwin

Austin, Texas

Mary Santiago
Prediction Tool for Thrombi Associated with PICC's

 I am a published author on this very subject.  We did a 233 pt. chart review of a  retrospective study that helps identify patients at high risk  for developing DVT's with PICC lines. Included in this article is a prediction tool that helps the clinician identify these high risk factors/patients. You can view and print this research article from our website by looking under the resource tab.  Certainly, more research needs to be done in regards to other high risk factors that we see in our pt's everyday, ie.. oncology pt's, history of DVT/PE, mult. IV sticks, vessel size vs. catheter size,  coagulopathies, decreased mobility etc..  Hope this helps!

Mary Santiago

Log in or register to post comments