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Elevated INRs
Are there any guidelines for inserting PICCs on pt's with elevated INRs? Also, if a PICC is placed on a pt. with an elevated INR is there any special dressing besides biopatch,extra gauze,tegaderm and pressure wrap?  Thanks in advance! 
i.I refuse if over
i.I refuse if over 2.8...otherwise your battling continuing bleeding. possibly for days!!!..wet site...potentially loss of catheter because the dressing is compromised...I have obtained epi-stop from OR..and chito-seal for stasis...they work well
Gwen Irwin
I think there are

I think there are discussions on this site from previous discussions that you could search.

I don't agree with INR over 2.8 being a point of refusal.  We have placed PICCs with INR over 4 without complications.  A PICC is definitely safer that a chest placed line with elevated INR, because you can place pressure on the site peripherally.

Please do a search for other comments about this.

Gwen Irwin

Austin, Texas

Although we  look at the
Although we  look at the whole picture r/t patient condition prior to PICC insertion and it comes to risk vs. benefit. I recall an INR of >9.0, the patient had received Vit K-and the PICC was inserted without incident. For some reason we have found that even with elevated INR or very low plts, these sites don't bleed like you would think. We make a very minimal nick only if necessary prior to inserting the introducer. It seems the few we have had that ooze, are the ones you least expect.
The few oozers we have had

The few oozers we have had (some don't start until several days after placement?) we have the staff place several folded 4x4's over dressing (not to change the dressing for 24h), wrap site entirely with Kerlix type wrap and the wrap with light pressure using Ace wrap. This has worked every time. If it did not work, I would then search for another reason such as a nicked superficial artery? or orther causes. We then have them change the dressing the next day. To keep changing the dressing is futile until the site settles down a bit.

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