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bauerke
PICCs left in clotted vessels
We have a patient that is positive for clots in the PICC arm.  The physician refused to have it removed.  He says there is research indicating that current treatment is to leave the line in and run heparin through the line.  What are your thoughts?
karrenberg
This is one of those issues

This is one of those issues that has research and documentation that goes both ways.  First and foremost it has to be documentated that it is a non-occlusive thrombus. After that, clinicians can go both ways.  Some leave them in, and treat with heparin.  Obviously, close monitoring is essential, so that swelling, circulation, etc is not compromised.  It may come down to how well the docs trust the nursing staff--is the monitoring of the affected site to be trusted??  Other docs pull out lines at the drop of a hat for  any reason just because they are afraid of the liability issues.

lynncrni
All discussion I heard at

All discussion I heard at AVA this year was to leave the catheter in place and treat. Removal and reinsertion in another site just adds to the risk of the same thing occurring in the new site. 

 

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

www.hadawayassociates.com

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

dfritz
So is the tpa infusion more
So is the tpa infusion more distal in the arm so that it will go through the "PICC vein" to "declot" the vein old news now?  Heparin is the drug of choice?  Why would you use one over the other?
lynncrni
All treatments remain an

All treatments remain an option based on patient assessment. There are no guidelines that recommend one over the other. 

 

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

www.hadawayassociates.com

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

Mats Stromberg
To keep the catheter whilst

To keep the catheter whilst treating the clot is what our our guidelines say, based on what our coagulation consultant thinks.

Lynn (or anyone else that knows), are there any references supporting this ?

Mats

Daphne Broadhurst
 Mats, a pilot trial we

 Mats, a pilot trial we participated in concluded: "Treatment of UEDVTs secondary to central catheters in cancer patients with standard dalteparin/warfarin can allow the central line to remain in situ with little risk of line failure or recurrence/extension of the DVT," as published in: Kovacs, M. , Kahn S, Rodger M et al. Journal of Thrombosis & Haemostasis. 5(8):1650-1653, August 2007.

Daphne Broadhurst RN
Ottawa, Canada

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

tessy
Hi, would you be able to

Hi, would you be able to send me a copy of this article or email me privately?  I have done a search and have come up empty handed.  I am doing some investigation as to who needs to remove a picc when there is a documented clot within the vessel with the PICC.  thank you for any help you can offer.

tessy465@aol.com

tessy
Hi I am looking for the
Hi I am looking for the article entitled: "Treatment of UEDVT's secondary to central catheters in cancer patients with standard dalteparin/warfarin can allow the central line to remain in situ with little risk of line failure or recurrence/extension of DVT" by Kovacs, M. Kahn, S. Rodger, M. et al.  The journal is listed as: Journal of Thrombosis and Haemeostasis.  I am wondering if it is safe to leave PICC in place or remove it, and who should remove it. Can anyone help?
Mats Stromberg
Thanks, I got your article

Thanks,

I got your article now, will read. Keeping the PICC in place works fine for us. Many times the coagulation consultant is consulted; this works as education for our physicians as well, as keeping the line in situ during thrombolysis can feel a bit scary. Clots stretching to central vessel or progressing clot in spite of thrombolysis means the line gets pulled.

Mats

Traci Fick
The question that has been

The question that has been raised at our facility - is does it have to be the doctor to remove a line with a documented clot? Is is anyone's practice for the nurse to remove the line in this circumstance? We haven't been successful at finding any literature to support either way.

Thanks if you can help.

 

amaguila2009
There is a small section
There is a small section discussing this issue in the attached document. Look at 8.4.2. It does not however discuss who removes the line. I'm thinking that if you don't have a ready intervention at the time of removal, how significant would it be who removes it?

Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
amaguila2009@gmail.com

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