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Norrie Rabinowitz
PICC Placement
We are an oncology PICC team and would like to know when placing power PICC's what the patient's INR has to be? Second question is does anyone have data to support that platlets don't have to be 50K and INR less than 1.5. Thanks so much
kokotis
there is no rule on INR and

there is no rule on INR and the placement of a PICC line as there is on a large bore central line placed in the subclavian or jugular

 It is a patient risk assessment.  The patient needs therapy and often that therapy needs a central lines or their venous access needs require a central line.  What would be the safest central line one can place?  It is a PICC

Kathy Kokotis

Bard Access Systems

Heather Nichols
It is the same at U of L in

It is the same at U of L in Louisville Ky.!  If you need a central line, a PICC is the safest line to place when bleeding is a concern. The only labs that really concern us is chronic renal. 

Heather

 

lynncrni
I totally agree - when there
I totally agree - when there is any increased risk of bleedin a PICC is by far the safest type of catheter to insert. The patient must have some type of line and a subclavian or jugular site would present greater problems if excessive bleeding should occur. With a subclavian site, there is no way to apply direct pressure to the vein or artery that could be accidentaly hit because the vein and artery lie under the clavicle. The jugular site might be easier than the subclavian for direct pressure but there would still be the chance of impacting the airway if a large hematoma formed, damage to large nerves and compression of the carotid artery. So it is a simple matter of looking at the other anatomy close by and knowing the possible outcomes. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

sesymons
I usually discuss this with

I usually discuss this with MD prior to placement.  If platelets are less than 20K or if INR greater than 2.5 the MD's can chose whether to treat with blood products prior to placement.

sesymons
I usually discuss this with

I usually discuss this with MD prior to placement.  If platelets are less than 20K or if INR greater than 2.5 the MD's can chose whether to treat with blood products prior to placement.

Nadine Nakazawa
You should know what the
You should know what the patient's coags are, but there is no limit to preclude placing a PICC.   Even peripheral venipunctures are problematic for these patients.  They end up with hematomas and no veins very quickly.   If any of you have Dr. Robert Schelper's CDs, he talks about why platelets are important for the integrity of veins.  If there are no platelets or very low platelets, there is no adequate repair of veins when there is damage (chemical or mechanical).   If the patient needs reliable venous access, then some type of CVAD is needed, and a PICC will be the safest CVAD and more reliable than PIVs.   No limit:  I've placed PICCs in patients with aplastic anemia with a plt ct of 1K.  We do lots of patients in end-stage liver failure---I've done pts with INR's of 6-9 (Heather you beat me, but I'll use your case as an example in my classes).

A major precaution, however:   Make sure you are really proficient with US PICc insertions before you attempt a patient at high risk for bleeding complications.  Maybe at least 30 to 50 insertions under your belt before you attempt an insertion in this type of patient.   You need to know where your needle is going!

Nadine Nakazawa, RN, BS, OCN, CRNI, VA-BC

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