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Regarding the original message about tPA in HIT - none of the literature that I have reviewed about HIT has included any risk factors for using tPA in these patients. HIT is an immunologic reaction to the heparin. Platelet factor 4 combines with the heparin to produce HIT-IgG antibodies. tPA is often used to lock catheters in patients when heparin is contraindicated such as those with HIT.
RE the question about Pt/INR for PICC insertion, there are no recommendations for this. A PICC is the safest catheter when there is any risk factors for bleeding and a search of this forum will yield lots of previous discussions about this topic.
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