But I would not take these articles to be strong enough evidence to
state that left arm placement should never be used. Again, it all
comes down to a thorough, complete patient assessment. I also have
not had time to review these articles and look at the actual numbers.
Many of these are review articles and not research articles. Lynn
At 12:43 PM -0400 8/14/06, Nancy Moureau wrote:
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 <http://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]
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Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
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