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christine m sch...
High INR/Low platelet counts r/t PICC insertions.

What guidelines does your facility have re: placing a PICC using microintroducer technique in patients with altered coagulation status?

mary ann ferrannini
Picc sites are

Picc sites are actually in many circumstances this would be the CVC of choice....we keep the tourniquet time down to a minimum if even used...apply pressure for a longer period of time..apply a pressure dressing and perform increased monitoring...on occasion we have to  apply some topical thrombin (usually in our new leukemia pts). I will review the chart and the labs and in some circumstances we can time it so it is placed at the optimal time...say for example.after platlet critical situations and when there is an urgent need this is not always possible and then you ask yourself the age old ?....risk vs benefit!!!!

Karen Day
Karen Day's picture
what is the topical thrombin

what is the topical thrombin you use.  thanks.


mary ann ferrannini
We have had really good luck

We have had really good luck with a product called D stat( patch). It activates a hanful of the clotting factors and is to control bleed at percutaneous sites. There are several versions of the product. The one we used can only be left in place for 24 we change the dressing at that point and re-apply prn..usually we do not have to though. The other topical product we have is thrombin-JMI a topical hemostat.

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