Are there written recommendations concerning how frequently PICCs can be declotted? In other words can it be done too frequently? The appropriateness of catheter management or lack there of aside, of course.
No standards or guidelines have addressed this question. tPA has a short half-life so its systemic effects would be very short. But common sense tells us this needs to be kept to the fewest number possible. If you are having repeated problems with the same VAD you need to figure out what is causing the problem. You may be dealing with extraluminal thrombus at the tip. I would first look at suboptimal tip location, especially on a VAD inserted from the left side. Cavoatrial junction is the best tip location and any site higher than that has increasing risk for vein thrombosis at the catheter tip. Lynn
No standards or guidelines have addressed this question. tPA has a short half-life so its systemic effects would be very short. But common sense tells us this needs to be kept to the fewest number possible. If you are having repeated problems with the same VAD you need to figure out what is causing the problem. You may be dealing with extraluminal thrombus at the tip. I would first look at suboptimal tip location, especially on a VAD inserted from the left side. Cavoatrial junction is the best tip location and any site higher than that has increasing risk for vein thrombosis at the catheter tip. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you again for your depth of knowledge. We hadn’t found a reference but knew you would know if anyone would. Thanks again. N.S.
Nancy S.