I wanted to ask everyone how they are handling these problems in their facilities.Â
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.Â 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)Â would you still remove the catheterÂ 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?
Â 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.Â 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.Â 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.