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Gwen Irwin
PICCs on the flaccid arm for stroke patient

What is your practice about using the affected arm of a stroke patient?

Routinely, we don't use that side.  We have had physician's question that.  Do you have any reference articles to help with that?

Gwen Irwin

Austin, Texas 

pafrn
 

 

lynncrni
The evidence comes from basic

The evidence comes from basic human anatomy and physiology. Look in the anatomy and physiology chapter of the new INS textbook, but this is in the 2nd edition as well as the 3rd. The muscle or venous pump action moves blood back to the heart by compression along with opening and closing of venous valves. When there is paralysis of an extremity, this muscle pump action is diminished or absent, therefore normal venous blood flow will also be slowed. Add a foreign object of the PICC to this situation and now you have 2 of the 3 pieces of the triad of Virchow, the process accepted for over 150 years as an explanation of the causes of thrombosis. Apparently, your physician needs to be reminded of the basics. 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

VAT RN
Our team also assesses how

Our team also assesses how severely affected the arm is. Totally flaccid or little movement with poor control then that arm is not an option. However, if they have gross motor movement and use the arm frequently we will consider it an option (not the first choice but an option). In this case we also look at dwell times, long term infusions or just this hospitalization.

Our team also feels that the lack of movement needs to be considered on patients that are intubated and sedated. We frequently place PICCs on Level 1 traumas with massive head injuries that are paralized and on neuro precautions.

We also argue with the doctors because we have been told the veins in the arm are "not deep, so it is not a DVT" and that most clots are asymtomatic.

Keep fighting the good fight, you will sleep better knowing you did right by your patients!

 

clhunchusky
Quadriplegics and PICCs contraindications?

 I am trying to locate research/articles/recommendations that clearly state that PICCs are contraindicated in quadriplegics, CVA patients with flacid or limited use of an upper extremity. Our facility does not place them on patients who do not have ROM in that extremity for the reasons stated in this post. One of our physicians is requesting evidence. Thanks for your comments.

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