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val wortley
upper extremity Thrombosis in adult oncology pts after PICC insertion


Does anyone have any strategies in place for preventing thrombosis in oncology pts particularly our breast ca pts. Obviously we do all the usual tricks such as finding the largest vein under ultrasound as possible and we realise that the underlying nature of the disease does make these pts more susceptible but it is distressing when these particular pts develop a thrombosis.


Vascular Access CNS


There are no specific

There are no specific recommendations to prevent catheter-related thrombosis in oncology patients. The disease process is creating the risk. The only thing you can do is choose a catheter size that does not consume more than half of the vein lumen, use slow gentle technique to minimize trauma to the endothelial layer in the vein wall, ensure correct tip location at SVC/RA junction, and ensure adequate catheter stabilization to prevent movement that would also disrupt the endothelium. The idea of using anticoagulation such as prophylactic warfarin is inconclusive and not widely accepted yet. You can also use standard nursing procedures such as ensuring adequate hydration as this contributes to sluggish blood flow and increased risk of CRT. Lynn

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

Reduce thrombosis

PICC lines are not the appropriate device for a cancer patient especiallly one undergoing chemo.  A port or tunneled line is appropriate.  The risk of thrombosis with this populaiton in the literature is at 10%.  That mean one out of every 10 cancer patients with a PICC line will have a DVT.  If you can live with that rate than it is acceptable in your facility.  There is no way to reduce this rate including prophylaxis which has not shown good results in the literature to date.

Good Luck

Kathy Kokotis RN BS MBA

Bard Access Systems

Lynn, I just wanted to throw

Lynn, I just wanted to throw out that Dr. Nifong's research puts the appropriate catheter vessel ratio at the catheter not taking more than 1/3 of the vessel, not 1/2.  Thanks.  CHeryl

Cheryl Kelley RN BSN, VA-BC

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