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SMM
INR

What limits do you use, or are established by your hospital, if any, about INR limits when placing ultrasound guided PICC lines?

INR

Our IR physicians recommended 2-3 stick only Basilic or Cephalic. Greater than 3 refer to IR. Our vascular physicians are not worried about any level.  we chose to go with what IR recommends.

Kris Pruner RN, VA-BC

Chris Cavanaugh
Meet the patients needs

There was an article in JAVA not too long ago regarding placing PICCs in patients with an elevated INR. 

I think you need to make a clinical assessment of your patient and decide what is best on a case by case basis, rather than having a set policy.  Ask, does the patient truly need central access?  If not, then place a peripheral IV.  If they do, then consider the options---a CVC (acute non-tunnelled CVAD) is 7FR-9FR, and placed in the IJ or Subclavian, both areas where it is difficult to hold pressure.  A PICC is 3Fr-6Fr (plus taper if you have a tapered catheter).   These are placed in the arm where it is easier to hold pressure if needed.  This is a case where the INS standard of using the smallest lumen possible (and taking a taper into account) is very important.

With the products available on the market (Bioseal, Quick clot) to control bleeding at the site, patients with elevated coagulation times and low platelets are becoming very managable.

Find out where your "limitation" number originated from...Is it from IR were they routinely access the arterial system with 10F and larger catheters? 

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

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