Hi Jenne If you have a nurse with expertise, she is as well equipped to place a PICC (and sometimes more so!) as IR. Here's what I ask/do:
1. Assess the pt thoroughly. Is PICC the best VAD option given the overall clinical situation? 2. Does PICC need to be placed now? 3. What is the source of the coagulopathy? For example, if the pt is on Coumadin, is it safe to withdraw and let INR decrease? If the source is liver failure, then go back to #1 and #2. We don't typically reverse the pt with Vit K or FFP in these situations. 4. Assess target sites with u/s. If you have a suitable target (patent, size appropriate), then I'd place PICC. Let's face it, if you don't place the PICC, the pt will most likely get stuck repeatedly with peripheral IVs and for sampling in addition to that. If you have bleeding at the site (and your labs aren't that terrible), then you can manage it with pressure dressings, D-Stat Dry, gelfoam, etc. Good luck. Gail Gail Egan Sansivero, MS, ANP Nurse Practitioner Department of Radiology Albany Medical Center Albany, New York 12208 518-262-5149 >>> "Jenne King" <[EMAIL PROTECTED]> 08/02 9:51 AM >>> Does anyone know if there is a cut off for INR value and nurses placing PICCs? Pt in question has INR of 4 and a PT of 41. It was suggested that a radiologist place the PICC, is this correct??? Jenne King Springhill Medical Center Mobile, AL ----------------------------------------- CONFIDENTIALITY NOTICE: This email and any attachments may contain confidential information that is protected by law and is for the sole use of the individuals or entities to which it is addressed. If you are not the intended recipient, please notify the sender by replying to this email and destroying all copies of the communication and attachments. Further use, disclosure, copying, distribution of, or reliance upon the contents of this email and attachments is strictly prohibited. To contact Albany Medical Center, or for a copy of our privacy practices, please visit us on the Internet at www.amc.edu.
