Are there thoughts on the use of a PICC line in the ICU setting for Levophed and dopamine and the incidence of developing DVT's of the extremity? We assessed a patient recently in ICU on Levophed. His vessels were not large enough for a PICC so another line was placed. Now we are thinking of the patient that is not on a vasoconstrictive drug when the line is inserted and what might the addition of one of these drugs mean for the PICC.  Thanks for your thoughts.
Forum topic
Tue, 01/20/2009 - 09:47
#1
PICC's and vasoconstrictive drugs
Are there thoughts on the use of a PICC line in the ICU setting for Levophed and dopamine and the incidence of developing DVT's of the extremity? We assessed a patient recently in ICU on Levophed. His vessels were not large enough for a PICC so another line was placed. Now we are thinking of the patient that is not on a vasoconstrictive drug when the line is inserted and what might the addition of one of these drugs mean for the PICC.  Thanks for your thoughts.
A PICC can be used for these drugs. I don't recall ever seeing any information, concern, warnings, or published studies that included this as an issue. If someone else knows of something, please let us know.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
I am not sure if there are any published correlations between high doses of pressors and DVT but usually people on Levo are also very septic and they do have septic emboli which puts them into a risk group of developing throbus everywhere and anywhere.
Just today I was asked to insert a "shorter" PICC in a septic patient on Levo, Dobutamine, and CVVH who had a very large throbus in her R atrium, with a vegitated Tricuspid valve, INR 8.9 PLT 40, who had cloted both her femoral veins (in one femoral she had a Quinton catheter, the other a non functioning CVAD) R IJ with a CVAD and a large clot too.
When I imaged her L arm, all I could see was one Brachial vein, that by some luck appeared to have a fairly decent size at mid upper arm. I am sure that if she was off the Levo she would have had more and better choices. She had black feet and hands from septic clots everywhere. I ended up putting a 5 FR dual lumen power PICC because the triple lumen PICC comes in a 6 FR and I felt that her vein was too small for that. The ICU team insisted the tip should not be deeper then the mid L subclavia because they were so worried about her right sided clots (the one in the IJ and R Atrium), it did not matter that I told them that a suboptimal tip placement put the pt at risk of developing throbus, I made the attending put in writing her request for the tip to be in the mid Subclavia.
To make a long story short, yes, a PICC is a good and safe line to infuse anything that a CVAD can infuse, and as for DVT, septic emboli are a known morbidity, and most patients on pressors are septic.
PICC is a great line to deliver all pressors, measure CVP and use it as any central line, whether the patient is in the ICU or not.