RE: Left arm thrombosis

[Nancy Moureau]

Title: Message

I understood your question, Rhonda, it just took a bit of time to provide you the references. There is an increased risk of thrombosis from the left especially when tip placement is high in the SVC rather than near the right atrial junction. I do not have time today to go through and find the individual articles and rates, but these are the primary articles dealing with thrombosis. Kearns research specifically shows an increased risk with left sided placements vs right.   Kearns PJ, Coleman S, Wehner JH. Complications of long arm catheters: A randomized trial of central vs peripheral tip location. JPEN. 1996; 20:20-24.   Loughran SC, et al, Peripherally Inserted Central Catheters; Guidewire verses Nonguidewire, USC A Comparative Study, JIN, 15:152, 1992.   Sansivero GE. Venous anatomy and physiology. Considerations for vascular access device placement and function. J Intraven Nurs 1998 Sep-Oct;21(5 Suppl):S107-14   Bagnall-Reeb H, Ruccione K, Practical Application of an Algorithm for the Thrombolytic Treatment of Occluded Vascular Access Devices, J Pediatr Oncol Nurs, Vol 10, pg 79-82, 1993.   Hadaway LC. Major thrombotic and nonthrombotic complications. Loss of patency. J Intraven Nurs 1998 Sep-Oct;21(5 Suppl):S143-60.  Vol 25, No 2 March/April 2002, pg 121-126.   Mayo DJ. Catheter Related Thrombosis. JIN Vol 24, No 3S May/June 2001, pg S13-22.    Smith JP. Thrombotic Complications in Intravenous Access. JIN Vol 21 No 2 Mar/Apr 1998, pg 96-100.   Brown-Smith JK, Stoner MH, Barley ZA. Tunneled catheter thrombosis: Factors related to incidence. Oncology Nursing Forum. 1990;17:543-549.         Nancy Moureau, BSN, CRNI PICC Excellence, Inc. 888-714-1951 www.piccexcellence.com [EMAIL PROTECTED]     -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Zenger Rhonda Sent: Monday, August 14, 2006 10:15 AM To: [EMAIL PROTECTED] Subject: Left arm thrombosis I apologize for not being clear with my question. What I am trying to find out is there any research based information regarding an increased incidence of thrombosis and/or complications when using the left arm for PICC placement. In the past, we would visualize both arms with ultrasound and then choose the arm with the best vein for access. However, I attended a workshop in Kansas City and the speaker reported an increased incidence of thrombosis is associated with using the left arm. He recommended the using the right arm first unless contraindicated and then using the left arm. Now, we use the right arm for PICC placements unless there is a contraindication then we use the left arm. One of our team members continues to use the left arm no matter what the situation is because the CRNAs have informed her it is the easiest and best approach. She also uses a close to the AC approach on the left arm. This makes it very difficult to take care of the PICC due to its location close to the AC. I am trying to change her practice approach, if possible. If anyone has any literature or information to support not using the left arm routinely and not choosing a low AC approach for PICC placements it would be helpful. We use ultrasound with MST. Thanks so much,   Rhonda Zenger, MSN, RN Advanced IV Services Mercy Regional Health Center Manhattan, Kansas 785-323-6835 [EMAIL PROTECTED]