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Diane Jack
White Thrombus?

When withdrawing blood from a PICC a white clump of material was obtained.  It was sent to the lab and the pathology report indicated it was a clot of fibrin/platelets.  I have seen some literature on this topic regarding hemodialysis blood lines and in units of blood products, but not specific to central venous access devices. Does anyone have any info specific to cvad's.  Wondering if there are any pre-disposing factors in the patient's condition, or bloodwork, and what is the risk to the patient? I see that back in 2007 in this forum there was some discussion regarding "fat" in aspirated blood.  I wonder is some of these could possibly have been a white thrombus. 

lynncrni
To me this suggest heparin

To me this suggest heparin induced thrombocytopenia. Did your patient have a drop in platelet count or was the platelet count very low? White clots made of fibrin and platelets is associated with HIT. 

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

www.hadawayassociates.com

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

Diane Jack
The platelet count was

The platelet count was normal.  PICC was valved, therefore only saline flushes.  Pt. was on s.c.  low molecular weight heparin

D. Jack, Nurse Clinician, Advanced Venous Access Service

Calgary, AB, Canada

lynncrni
HIT incidence with LMWH is

HIT incidence with LMWH is lower but it can still happen. The normal platelet count seems to rule out HIT though. 

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

www.hadawayassociates.com

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

fizerjk
How long had the catheter

How long had the catheter been in place?  Could it have been the tip of a fibrin sheath that was aspirated back into the catheter and broke away on aspiration. I have seen them covering the tip of catheters on removal.

Jeffery Fizer RN, BSN

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