Forum topic

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. 

hi

When inserting a PICC line, there are instances where I need to access a vein lower than the location of the thrombus. In rare cases, I may have to puncture an area of the vein that is only partially patent. Each situation must be approached individually, particularly in geriatric patients where these complications are more likely to arise. This is especially true when Nephrology United recommends inserting the PICC line in the opposite arm to avoid disrupting hemodialysis access. For cases involving central thrombus, using fluoroscopy to guide a wire can be beneficial, allowing us to position the tip in a patent area of the superior vena cava. Additionally, offering a Midline service presents a valuable alternative.

Not sure what  Nephrology United is. In the USA, we follow the National Kidney Foundation Kidney Dialysis Outcomes Quality Initiative and a PICC is not recommended for either arm. The goal is vessel preservation for futrure needs for grafts or fistulas.