In my opinion, a PICC would always be the best choice for vascular access and therefore best practice in the presence of any elevated coagulation values. The reason is that there is no critical organs nearby that could be damaged from excessive bleeding. Subclavian sites could compromise the apex of the lungs. IJ could compromise critical arteries, nerves, etc. Also, the site of a PICC insertion is much easier to control any bleeding because direct pressure is easier to apply. With subclavian, the clavicle is in the way.
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
I put PICCs in pts with INR of 4, 5, 8, and up to 12 the last one. Did not lose a drop of blood. All MD's refused to put in CLC for this last pt and they wanted a PICC.
The oncologist I know said that I just have to pay more attention to platelet level. He said above 17K was good enough for PICC insertion.
I often place PICC lines in patients with high INR levels and have not had any problem with excessive bleeding in these patients. In fact, a PICC is the safest central line for these patients, in my opinion.
Intermountain Medical Center
I agree with the other posters, and would add a caution to do whatever you can to prevent hematoma formation deeper in the tissue, possibly causing compressive nerve injuries (usually median, ulnar nerves) that can lead to complex regional pain syndrome.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center