Hi all. thoughts, protocols, opinions on a pt with a PICC line in an arm with an extensive DVT. PICC line dwells in basilic, with no flow, DVT extends to axillary vein, no flow and to the subclavian, no flow. Would you remove this picc line if asked and order was placed, or recommend removal with IR under fluoroscopy? Pt interestly enough was also taking plavix and ASA. thanks all for your input.
Before you consider where and by whom the catheter will be removed, there are some other questions that should be addressed.
1. Does this patient continue to require a central line after considering the remaining length of infusion therapy and its characterisitcs?
2. Is the catheter tip in the recommended position in the lower SVC near or at the cavoatrial junction?
3. Is the catheter functioning with a good blood return and no resistance to fluid flow through the catheter?
4. Are there any signs or symptoms, concern or thoughts of bloodstream infection being present?
5. Is the patient complaining of pain, tenderness, in the arm with the PICC?
For the answer to 1, 2, and 3 is Yes, and the answer to 4 and 5 is No, then the catheter should not be removed. The patient should be treated for DVT for as long as the PICC is needed and for 3 months after it is removed. This DVT is a clear sign that insertion into another vein will produce the same outcome.
For a reference for this, see the INS Standards 52 CVAD Thrombosis and Standard 44 VAD Removal. The medical references for this is found in VAD Removal standard.
Lynn
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
THank you for you reference!
Yes, to 1, 2, & 3 # 4 is no. NO pain nor tenderness in the arm, although gross edema
Tracey Roulinavage RN BSN VA-BC