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diane deldotto

 I work at a large medical ctr with a program for stroke treatment. The IV staff disagrees on the placement of piccs in the weaker stroke arm. Of course we'd all rather have a stronger healthy arm, but these days our patients are very ill. I would appreciate any input from other IV teams that place piccs with US.

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Diane DelDotto CRNI

An extremity affected by a
An extremity affected by a stroke or any cause of paralysis is a contraindication for placing a PICC or any other catheter such as a PIV. The reason is an increased risk of catheter-related thrombosis. Normal blood return occurs because of the muscle pump action. The muscle contraction compresses the vein causing blood to move back to the heart. Paralysis has stopped this normal mechanism for blood return causing venous stasis in that extremity. Adding a catheter dramatically increases the risk of thrombosis in that extremity. So the technique used for placing the catheter is not the issue. Paralysis-induced changes in blood flow plus the presence of the catheter is the issue. I have seen this happen in the early days of placing PICCs back in the early 1980's, so I would never recommend that these arms be used for any infusion therapy. My mother has a paralyzed arm from a stroke and I would never allow her to be stuck for any reason in that arm. Lynn

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 suggest a risk benefit

I suggest a risk benefit analysis by patient

Can they have a jugular line or subclavian line?  If being sent to a nurisng home this line is not appropriate unless it is a cuffed tunneled line.  Look into what is called a SBCC which is a cuffed 7 french line placed by IR in the peripheral veins, jugular or subclavian

Since you have only one arm to work with peripheral lines are not an option either.  Look at other choices of central vessels and if those are not an option and the patient needs to leave the facility a PICC may be the right choice.

Kathy Kokotis

Bard Access Systems

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