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Karen Day
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superficial thrombus and dvt's

I wanted to ask everyone how they are handling these problems in their facilities. 

It is my understanding that if a patient has a superficial venous thrombosis or DVT in their upper extremity prior to picc placement, you would avoid placing a line in that extremity.  In instances where a picc is in place and a thrombus or DVT is found what are your currenty guidelines?

If non-occlusive or in a vessel not involving the picc directely (i.e. cephalic vein and picc is in the basilic) would you still remove the catheter or treat with LMW and/or coumadin and monitor the extremity.

If occlusive, do you remove immediately or treat with LMW and/or coumadin for a set period of time and then remove?

 In many instances, we are finding that the physician orders for the catheter to be removed and a new one placed in the opposite extremity.  We caution them that the presence of a DVT although in the opposite extremity, significantly increases the risk of the patient developing another thrombus/DVT in the extremity of the new picc line.  Unfortunately, these patients require venous access and would benefit from a CVAD (teams are hesitant to place a subclavian or IJ due to the infection risks)

I recently came across this study I have attached and would value your input.


The way I've presented this
The way I've presented this issue to some of our physicians is that the factors of thrombogenesis involved in the patient will not change even if we move the device to the contralateral extremity. For the sake of vein preservation as well as the definite need for the access device, I've recommended that we keep the PICC and treat with LMWH or drip. Of course I also ask them to reorder a doppler in 2-3 days to monitor the DVT for progression/extension. I had great support from our vascular surgeons as well regarding this topic.

Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]

Karen Day
Karen Day's picture
that's a terrific response,
that's a terrific response, thanks for the info.
wanda shade
Is there an expected DVT
Is there an expected DVT rate for PICC lines?
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Below are the vascular access guidelines on thrombosis from Society of Interventional Radiology done in 2004.  They are the only guidelines on thrombosis to date


Kathy Kokotis

Bard Access Systems

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