Hi Everyone, I have a PICC line at my facility that is needing frequent TPA to establish blood return. The line flushes well but rarely gives a good blood return. We are having to TPA the line several times a week to establish a blood return. We have done repeat chest xrays to establish tip placement and the tip is in the proper place. The patient doesn't have the greatest range in his arm so we can't do a lot of manipulation of the position of the arm. He is receiving zosin every 6 hours. No hypercoagulability noticed from his labs. Would you be comfortable instructing the nurses that it is okay to use this line without the presence of a blood return? Any suggestions on how to better establish a consistent blood return?
A chest xray is not enough to diagnose your problem and hypercoaguability is much more than just lab work. This PICC could be positioned against the vein wall. It could have a thrombus surrounding the tip inside the vein, instilling tPA willl not reach all of this thrombosis so it regrows. There is most likely a fibrin sheath around the catheter also and again instilling tPA is not sufficient. Diabetes, oncology diagnoses, and lack of mobility increased coaguability. I would get a contrast study in radiology. Have them inject contrast under fluoro to see what is actually happening with the catheter. What was the catheter to vein ratio when it was placed? I would bet there is a thrombus in the vein near the tip, but hope not. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861