Not intending to say never use the left arm, just prefer the right. 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 Lynn Hadaway Sent: Monday, August 14, 2006 1:27 PM To: [EMAIL PROTECTED]; 'Zenger Rhonda'; [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] Subject: [vascular] RE: Left arm thrombosis 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] > > > > > >[Non-text portions of this message have been removed] > > > >MedComp Proud Sponsor of the Vascular List Serve. >Yahoo! Groups Links > > > > -- Lynn Hadaway, M.Ed., RNC, CRNI Lynn Hadaway Associates, Inc. 126 Main Street, PO Box 10 Milner, GA 30257 http://www.hadawayassociates.com office 770-358-7861 MedComp Proud Sponsor of the Vascular List Serve. Yahoo! Groups Links <*> To visit your group on the web, go to: http://groups.yahoo.com/group/vascular/ <*> To unsubscribe from this group, send an email to: [EMAIL PROTECTED] <*> Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/
