We place PICCs in patients with severe coagulopathies. For example,
aplastic anemia patients with a platelet count running around 1-2 K, and
they are refractory to platelet transfusions. We also have a large liver
failure population. We have done patients with INRs of 6 or greater (and
I've heard of others doing it in patients with INRs of 12 to 18!).
I usually contact the referring physician to alert them to the platelet
count and ask them if they want the patient transfused prior to the
insertion. I remnd them that we are in the venous system and we have little
excess bleeding or bruising when placing PICCs in patients with severe
coagulopathies. When I get consent, I tell the patient that bleeding is a
very real risk for them, and a greater risk compared to patients without
coagulopathies. However, usually by this point their arms and veins have
been so abused they are ready to take this chance.
The point is that if the patient needs the access (and they invariably do),
then a PICC is the safest VAD to place. However, the inserter should be
very experienced with ultrasound PICC placements with at least 3 to 6 months
or 50 to 100 insertions under their belt. They should be very comfortable
with difficult venous access, especially when accessing brachial veins.
They should try to avoid the brachial veins if at all possible, or access a
large brachial that is easy to get to.
In other words, we do not have a lower limit to which we will NOT place a
PICC or insist on supportive treatment prior to the insertion. We do
communicate with the physician team, however, and assure them that we have a
high success rate with low complications if they wish us to proceed with or
without transfusions.
Nadine Nakazawa, RN
Stanford Hospital
From: "PCMH VAT" <[EMAIL PROTECTED]>
To: "list serve" <[EMAIL PROTECTED]>
Date: Thu, 21 Sep 2006 07:19:39 -0700 (PDT)
Was wandering what some paramaters for Coags are, for bedside PICC
placement. Please include some rationale....Hello Cindy Schrum....
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