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PICC placement in OB patients

We have had some problems with thrombus formation in our adults on the OB service.  We are using the BARD groshong, Power PICC and the PICC Solo on these patients.  The lines have been placed with & without ultrasound.  We would like to know if any others are having problems this patient population or have found solutions to this issue.  I would appreciate all input.


OB patients are in a

OB patients are in a hypercoaguable state, due to the extra blood circulating due to the pregnancy.  It is possible that the line you are placing is taking up too much of the inside of the vein,  not allowing enough blood to circulate around the line, leading to stasis surrounding the PICC.  You injure the vein when you punture to place the line, and possibly also when you are threading a cut edge, blunt tip PICC, if you trim.  You now have all 3 of the points of Virchow's Triad, which explains how thrombosis forms.

You may want to take a look at the size of the catheters you place, they have a reverse taper that increases up to 2 FR sizes at the hub and up to 7 cm from the hub.  Taking up too much of the vein, 30% to 50% based on literature, may be contributing to the increased thrombosis. 

Patients in the puerperial

Patients in the puerperial state have higher risk for phlebitis and thrombus, as noted by IV RN (what's your name, IV RN, and where are you from/where do you work?)

I'm assuming that if you're placing PICCs without ultrasound guidance, you're either placing them in the cephalic vein, or accessing a vein in the antecub.  Either of these would add another risk factor, especially with the pistoning caused by bending at the elbow.

We are usually able to get a 5Fr Bard catheters in most people's veins, and have plenty of vein/blood around catheter to spare.  Some of our nurses are concerned about the reverse taper and leave a few centimeters of catheter out.  Either way, I don't recall problems (that we're aware of) - though I do remember one case of a post-partal woman with vonWillebrands disease (clotting disorder). That patient had symptoms of a bacterial shower upon catheter removal, and I'll bet she did have a thrombus.

Have a conversation with the MD(s), and you might want to inquire with a coagulation or hematology specialist. 

But DEFINITELY use ultrasound to place all of your PICCs. 



Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

See Medscape Article: 

See Medscape Article:  "PICC Lines Risky in Pregnant Women with Hyperemesis"

Heather Nichols
I had an OB attending at

I had an OB attending at my facility recently tell me that he "did not like PICC's in his pregnant patients because the got infected a lot". That was his exact words. I, of course, asked for his proof, but he could come up with none. I also looked for articles on this issue and could find none that pertained just to being pregnant. Any patient with serious dehydration (hyperemesis) will be more prone to clotting, but that is not "all" pregnant people. I had my PICC for 3 months while pregnant with no problems, and it was to treat a clotting disorder, so twice the risk.

While using the power picc and the solo in our facility, we had an increase in thrombus formations. I can only think that this would be majorly compounded by the lack of ultrasound use. We do not PICC many pregnant women here, but the one's we do PICC are high risk usually. We have not seen any increase in thrombus or infection in these women. Let everyone know what you find out.


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