As a "general rule", I think, veins increase in diameter as we move from the periphery to the central veins. In terms of veins used for PICC placement, and as the vein /catheter ratio gains attention and discussion, will this "general rule" above be a given for placing PICCs? I just read Jack LeDonne's question in the Fall 2016 Vol 21 Num 3 of JAVA and this question came to mind. Just curious in what others think. Thanks for any replies.
IMHO, it already is a standard of practice because it is addressed in the INS Standards of Practice, See #44 Vascular Visualization. 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
The above study will clearly show that the risk of DVT from a 6-7 FR is higher. 6-7 Fr....not a 5FR. So I think your safe. As with anything though; patients condition, disease process, mobility, insertion trauma all play a more important role. Remember, modified Seldinger has been around at bedside for about 17 years. PICC's were placed in the A/C fossa for alot of years before technology, so for the Vascular Access folks that placed so many PICC's the old way...how did you measure vein diameter?. And if you didn't, did you see an alarming DVT rate?
Jack
With the advent of MST we had no regard for vein diameter. We could place in practically any size vein and yes we did see an alarming phlebitis and DVT rate.
Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA
We read that question too. From January of 2015 through March of 2016, we had 50 DVTs out of about 600 lines(PICC and Midline) placed. In April of 2016, we abandoned evaluating veins with a tourniquet and really focused on adequate vein diameter. In the last 7 months, we have had a total of 9 DVTs while placing the same average number of PICCs. Even with 8 months of data collection ahead, it is clear to us that vein diameter matters enormously and that we have reduced our DVT rate by more than half!
Every month we review the upper extremity doppler results done that month. I would be curious to know how other teams are doing DVT surveillance.
Genine Schwinge, ANP-BC, PNP, VA-BC
Hi Genine,
I ,for one, would love to hear more about your results. It seems impressive that your DVT rate dropped, but can you offer any
more specifics? What diameter criteria did you use?, was there diagnosis related similarities like cancer, immobilization, Stroke, multible IV attempts by others before you were called in. I would love to hear how that study went. But you dropped from 50 to 9. that's is clinically significant and would certainly warrant a clinical discussion.
The other variables you mention remained unchanged from one group to the next, including catheter type/brand and inserters (no changes). Since we are still collecting data, we will look at these other factors.