Get a lot of orders for lines on arms with clots. Our team definitely does not place on arms with DVT, but the question is the language used after ultrasound check on arms such as occlusive and non occlusive thrombus or superficial thrombus. Should you place PICC/MID on these people? Is there and evidence or INS standard to support this? Could you please help and thank you
There is an INS SOP on Catheter Associated Vein Thrombosis. Deep vein thrombosis is a contraindication for a PICC and midline because there is a high risk of a new thrombosis with the catheter. Superficial vein thrombosis may or may not be an issue. Usually SVT is caused by previous inappropriate catheter or site selection or incorrect infusion methods and techniques. This is probably not a contraindication for a PICC or midline but it depends on where the SVT is located. If in a distal vein or the opposite arm, a PICC or midline might be ok if the patient doesn't have other risk factors for thrombosis - eg diabetes, cancer, pregnancy, etc. If the SVT is in the same vein or near the proposed PICC or midline insertion, I would not insert because the current SVT could extend to the vein location of the new PICC or midline.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861