What guidelines does your facility have re: placing a PICC using microintroducer technique in patients with altered coagulation status?
Picc sites are compressable..so 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 administration......in 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!!!!
what is the topical thrombin you use. thanks.
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 hrs...so 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.