1. Are you experienced in using ultrasound and MST to place PICCs? In other words, how experienced are you with small veins, brachial veins, deep veins, etc? If you've done at least 50 to 100 PICCs successfully with MST & US, then you're ready for more challenging patient situations.
2. Think about it...If you place PICCs every day, all day long, then you will have as much or more success than the IR docs. They have fluoroscopy to get it there faster but you will have just as much skill in getting in that PICC.
3. If you think about it, the safest central line is one that avoids hitting the lung or deep and large arteries. If you hit the brachial artery, even with coagulopathy, it's easy to apply pressure and you've only put in a 21 g needle.
4. In answer to your questions, we've put in PICCs in patients with ITP with plt counts of 1 K, and in liver failure patients with INR's of 6. I've heard of PICC nurses placing PICCs in liver failure patients with INRs of 12 (and I think someone said 18!). Vit K or FFP will likely not make a lick of difference. BUT you must be very experienced, tell the patient that they are at much higher risk of serious bleeding/bruising, but if they need the access, it should outweigh the risks.
Until you gain that experience, then refer the patients to IR.
From: "Jenne King" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: lab values
Date: Wed, 02 Aug 2006 07:51:07 -0600
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
