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Treatment of Occlusion occuring in basilic or cephalic vein

Here at my facility we have recently experienced an accurance where pt had developed an occlusion related to PICC placed in the basilic vein. It was brought up for discussion that because the basilic vein is a superficial vein should the standard DVT protocols be followed?

Could anyone please provide supporting literature for treatment of patient with occlusive thrombus in the basilic or cephalic veins in the upper arm?

 

Gina Ward
when you say an "occlusion" 

when you say an "occlusion"  are you referring to an occluded lumen or are you saying that had an ultrasound and they have a thrombosis?

An occlusion once properly assessed and determined not be  an external kink, catheter malposition, damage  and most likely fibrin sheath is treated with Cathflo Activase.   This is a fibrin sheath not a thrombus.

If it is a thrombus , verified by ultrasound of the extrememity then that is treated differently.  Treatment options take into consideration alot of things;   pt symptoms  extent of edema , extent of thrombus ( full occlusion, partial occlusion with blood flow around  etc...as noted on us report) ,  other vascular access needs and access options....    if the clot extends from the baslic to the axillary and or subclavian it is   typically managed with anticoagulation however many times the line is left in place and others it is removed.  It is a very individual plan of care and each doctor seems to handle it a bit differently. 

That is how it is typically managed at our facility.

I have seen  literature with an algorythm on how to manage and wether to keep the line or not when there is a diagnosed thrombus that actually includes determining if it is superficial or deep depending on the vessel selected as well as medical managment  but......not sure what its titled.   I think I have found it before on a google search and it was presented long ago in one of the conferneces I have attended. 

Sorry I couldnt produce the aritcle but wanted to atleast share how it is typically handled at our facility.

 

Gina Ward R.N., VA-BC

lynncrni
Occlusion is most commonly

Occlusion is most commonly used to describe some form of intraluminal blockage inside the catheter. If you are asking about the vein being occluded, that is usually referred to as catheter associated vein thrombosis. The basilic vein is a deep vein where the PICC is inserted. It is a superficial vein in the forearm and through the ACF, but dives under the muscle sligthly above the ACF to become a deep vein for the remainder of its length. So you are entering a deep vein. The standard of practice is to leave the PICC in place IF the tip is correctly positioned at or near the CAJ, there is a blood return and there are no signs or symptoms of infection. There may need to be anticoagulants started. Removal of the PICC and insertion of another will only cause this problem to repeat itself at the new PICC. Please read the INS SOP on Catheter Related Thrombosis and the list of references supporting this standard. 

If you are asking about catheter lumen occlusion, see the INS SOP on CVAD Occlusion. 

 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

I was referring to a venous

I was referring to a venous thrombus. Our IR department informed us that we were treating a patient with a venous thrombus in the basilic vein ( accessed in the upper arm for PICC insertion) incorrectly as the basilic was a superficial vein. I was taken aback as I had never heard of such. Your clarification that in the forearm is is considered superficial but in the upper arm it is considered a deep vein makes perfect sense. However, when I was looking through literature it repeatedly said that a DVT should be differentiated from a Superficial thrombus occuring in the basilic or cephalic vein. I did look at the INS recommendations however it refers to the treatment for a DVT. Not specifying the location). thank you so mych  for your reply  and if you could give a reference for this differentiating definition of deep veins I would greatly appreciate.

Christian L. Meyer RN, VA-BC, CVAT team UAB

lynncrni
Infusion Nursing - An

Infusion Nursing - An Evidence Based Approach, the green INS textbook, A & P chapter

Grey's Anatomy. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

thank you so much

thank you so much

Christian L. Meyer RN, VA-BC, CVAT team UAB

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