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mary ann ferrannini
Upper extremity DVT with PICCS lines (sudden increase)
 Recently we have had an increase in upper arm extremity DVT (usually in our PICC vein) but sometimes below the site where there has been an IV site at the ACF. We have noticed that the majority were in woman and the majority were polyurethane  PICCS. Overall, our rate was 4.16 % in Jan. The powers that be are a bit concerned about this and from what I have read this is a totally acceptable rate. This percentage is actually high for us and they all seemed to occur in Jan. Just a fluke? what does everyone consider expected  rates of UEDVT to be in regards to PICCS . We need to show them this is OK.  
The old concept of trying to

The old concept of trying to benchmark your rates of any complication against a published rate is outside the accepted way to think about this currently. For instance we now think that all hospital acquired CRBSI is preventable. So a zero rate is the goal. We have not applied this approach to vein thrombosis yet, but it is something worth considering. 

You mentioned 2 risk factors for thrombosis. Women generally have veins of a smaller diameter than men. Previous sites in the antecubital fossa would leave vein trauma that is compounded by placing a PICC in that same vein. You did not state the size catheter being used. 

Also are you scanning all your patients for vein thrombosis? If not, then this rate is only based on those that are symptomatic, which is usually a very low number. You probably have a very large number of vein thromboses associated with all CVCs but they do not produce clinical signs or symptoms. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Gwen Irwin
We had a fluke of increases

We had a fluke of increases of DVT in pedi patients about 3 years ago.  We could find no common thread at all.  Different ages, male/female, many diagnoses, different infusions, etc. We decided to continue to monitor and didn't have that rate again.

I agree that the common thread for your patients are women with smaller veins.  Which vein?  How big was it measured on ultrasound before insertion?  What size catheter?  The number of PICCs placed above previous IV sites?  Who is doing the insertion?  Was it a traumatic insertion?  These findings would be what I would look for and develop an action plan based on that analysis of data.  If no common factors, maybe a fluke........

Gwen Irwin

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