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Renal Patients, Thrombosis and AC IVs.

There is so much talk about not placing piccs in the arms of renal patients.   I truly understand the concern for preserving their access.  However there does not seem to be the same concern about placing IVs in the antecubital fossa.   This practice has become rampant in the ER and floor nurses are following suit.  As a picc nurse using ultrasound we are encountering thrombosed upper extremity vessels on a regular basis due to this fact.  In our hospital last week two piccs were requested to be removed because DVTs were found in the same extremity. Sad thing is the picc veins were clean all the way to the subclavian.  Both scenarios related directly to the peripheral IV infusions given prior to the picc placement.  Fortunately I headed one off at the pass but the other was removed needlessly.   I'm just on a soapbox here because piccs have gotten a bad rap.  Much of which I think comes from the pre-ultrasound days when phlebitis rates were high.  I would love to have the time and resources to follow up on post picc removal thrombus as well as the incidence related to antecubital IV sites.


I have been practicing
I have been practicing infusion therapy and vascular access for more than 35 years. Since my first day, I have always been taught and still teach that areas of joint flexion must be avoided for all PIVs. This includes the wrist and antecubital fossa. If you are forced to use these sites because of lack of other viable sites, then an armboard must be used. This is now and has always been basic principles of infusion therapy. This is the single most common thread among every legal case I review - areas of joint flexion for the PIV that leads to infiltration and extravasation and serious long-term outcomes for the patient. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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