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sesymons
increase in thrombosis

It has been brought up that there seems to be an increase in rate of thrombosis in our picc patients.  So now i am taking a look at our stats and checking to see what type of catheter used, how many sticks, how many are repositioned, inserter. Any thoughts on what I should be looking at or for? Or how i should be going about addressing this issue? We do use ultrasound.

Sharon Symons

SGH

 

lynncrni
Are you also looking at the

Are you also looking at the vein diameter when you place the line with US? Do you consider this when choosing the French size of the catheter? Inserter skill level, patient risk factors such as cancer or diabetes, and tip location are all critical factors brought out in other studies. How are the diagnoses of vein thrombosis actually made? Are you conducting these same tests on all patients or only those that are sympotomatic? The majority of all CVCs will have clinically silent vein thromboses. So this must be considered when analyzing your data.  

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

lrasberry
If you are using a reverse

If you are using a reverse taper catheter, how much of the proximal portion is inserted. Some reverse taper catheters are 1-2 French sizes larger as far down as 8cm.  So this means tht the largest part of the catheter is in the smallest part of the vasculature.

You really want to look at  your catheter to vessel ratio

Just somethings to consider

momdogz
In addition to the other

In addition to the other posts, I would add that a key word you used is "seems". Even if you were able to locate and tally all of the PICCs in your patients that were symptomatic for thrombus - what data would you compare it to?  How many variables would be involved with that data (vein/cath ratio, patient risk factors, inserter skill/#of cannulations, pt. vascular access history, etc.).  

Without good studies using pre and post doppler assessments and controlling for variability, length of study time,  and sample size - not sure how helpful your data will be.  

Thrombosis is a serious issue, and we do need to pay attention to it.  And - I wouldn't let anyone "seems" you or your team.  Ask them for their data. 

 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

pafrn
Hi Sharon,it's me

Hi Sharon,it's me Patti.....in response to your post, when you stated that it was brought to your attention that there seems to be a rate increase in thrombosis with your PICC patients, I am going to take a different spin on this from my own past experiences with this type of ambiguous statement.  I am curious.....who has noticed this.....and is it more than one source as sometimes I have found that a statement may be made that sounds like many numbers are involved where in reality it was really only less than a few or if even that....like 1 patient in reality.  Where I used to work we followed every PICC patient post-placement through out the hospital stay so we were able to stay on top of all associated developments so immediately we could come up with answers to statements that were made especially ones that may be exaggerated, etc.  So going back and taking an inventory of the items you mentioned is a great place to start along with the other great suggestions given to you on this forum.  Also, what catheters are you presently using?.....and have you been able to link to date one catheter that this situation could possibly be connected with if you find there really is an issue at all.  It will be interesting to follow how this unfolds for you....good luck.  

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

lrasberry - who do you work for since leaving BD?  Arrow or Angiodynamics

kathy

Kathy Kokotis

Bard Access Systems

sesymons
Thanks everyone for your

Thanks everyone for your responses/advice. I am on it

sharon

afruitloop
When assessing occlsuion
When assessing occlsuion around the catheter, you may very well be able to assess the blood flow around the PICC catheter after you have placed it.  The pre-assessment technique that you have done prior to the PICC placement could certainly be applied to a post assessment after the catheter placement.  Use your ultrasound to assess for vessel wall thickness, coapt ot the vessel, "softness" of the vein, blood flow around the catheter, dilation of other vessels in the extremity, etc.  Good luck!

Cheryl Kelley RN BSN, VA-BC

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