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Amy Graham
PICC line will not clot.
I have a patient with leukemia, platelet count of 8.  I have placed two picc lines in patient. 1st line was 5fr dual lumen power picc, easy insertion, 1 stick. No bleeding, no problems with this line.  Placed second PICC on friday, platelet count still 8. 5 french dual lumen groshong picc placed. Very difficult placement, 3 attempts to basilic and 2 attempts to cephalic. Was able to place on 2nd attempt to cephalic. Pt continues to steady ooze from new picc line.  No oozing from attempt sites. Let me state that I use ultrasound and mst for placement. 21 gauge needle used. Any suggestions.  Have held pressure on serveral attempts, will stop bleeding and then starts back up. Thanks for any suggestions.    
You could try a pressure

You could try a pressure dressing,such as Coban/Coflex. Dress snugly and make sure there are frequent circulation checks to the arm.

How much of the Groshong PICC is out of the arm? Can I guess it's more than 5cm? If so,you don't have the reverse taper end to act as a plug in the insertion tract or the vein.

Good luck.



I truly believe we

I truly believe we should not have to rely on a "reverse tapered" PICC to reduce bleeding from an insertion site. There are MST kits out there that are smooth enough to keep you from making a skin nick. We place the reverse taperd Bard PICCs, but I tell my co-workers if you are putting that PICC in all the way to the up you are really placing a 7 French catheter (if the PICC is 5 "French" double). Use a BioPatch or a pressure dressing if the bleeding is too much.  




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