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References for PICC placment with low PLT or high INR

Oh great Vascular Access Nurses of the World,

Do any of you have any literature supporting the fact that a patient with low platelets or high INR could qualify for PICC placement?  I have been practing this for years, but was recently asked for a reference to provide to a physican that does not support PICC placement in this population.

Have a great holiday and I hope Santa brings you all of the Ultra Sounds, navigational devices and extra staff that you wished for.

 Cheryl Kelley



Hi Cheryl: Recently the Main

Hi Cheryl:

Recently the Main Line Health System in Pennsylvania has completed a limited study on the Effects of INR levels on Bleeding Occurrences During the first 24 hours of Ultrasound Guided Picc line Insertions.

I have attached the manusript and Power Point documentation they have provided me.

Lois Rajcan BSN, RN

IV/Picc team

Chester County Hospital

West Chester, PA

If this manuscript is

If this manuscript is intended for publication in a peer reviewed journal, having it posted here may endanger its acceptance. Just thought I would mention it. If it is meant to be a white paper only, there is no problem.  


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

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Hi Lynn, I am responding to

Hi Lynn, I am responding to this for Linda and Maggie at Main Line Health and and they would like you to pull their article from the website as it is soon to be published in the  AVA Journal. We stumbled on this website and found that their article was being discussed and they are very concerned about it.    Thank you

Lynn,  Yes, please pull
Lynn,  Yes, please pull this article from this website. Thank you, PICC team at Main Line Health
Lois, I am responding to ask
Lois, I am responding to ask you to remove this article from the website, as it is soon to be published in the AVA journal. Linda and Maggie (the authors of the article) are concerned that it is "out there" and being read before is it actually published. I don't know what effect it will have on the publication, but they would appreciate that you not share it elsewhere.  Thank you, Nancy, PICC Nurse Main Line Health System
Gwen Irwin
We don't have literature,

We don't have literature, but our experience with tapered PICCs has increased the number of PICCs in patients in this category.  We have had patients with platelets as low as 9,000 and INR over 4 with successful PICCs and no significant blood loss.

In light of the patient's risk, a PICC is a lower risk than any chest placed line.  Applying pressure on the arm is so much easier, if there are problems.  This is why we have attempted these PICCs and have noted less complication.

Gwen Irwin

Austin, Texas

Thank you Lois for the

Thank you Lois for the presentation and paper.  It was great.

 To others, yes, I know what we all are saying, I have practiced that for years, but as we know, literature supporting a practice is needed.  That is what I need.  I appreciate it.

Cheryl Kelley RN BSN, VA-BC

I do not know if the plan is

I do not know if the plan is to publish this study.  I got this directly from the Picc team Main line Health system.  If this will endanger their acceptance or if there is a slight possibility of endagering their publication, I will remove the attachment.


Thanks Lynn for the heads up.

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