RE: DVT with picc line

[Ward Gina]

Title: Re: reverse tapering

Hello all,

 

sorry to attach to a prior email but I seem to be "not allowed " to send a mail to the group.

 

Pt scenario  I need some guidance with;

 

Pt in hospital needing TPN after surgical complications (carotid endarterectomy then suffered vocal cord paralysis as well as dysphagia requires g tube etc.  ) ;  I insert a picc line right basilic vein ( 2 attempts)  on 9/28 , on the next day he has a partial occlusion in one of the lumens.  I use cath flo activase successfully ( his surgery had been 2 weeks prior).  Patient ready for discharge and I come to remove the PICC line on 10/4 , line removed intact  insertion site  good and no redness, edema, etc...but I did notice a significant amount of bruising on that arm below the picc insertion site ( he did have scattered bruises elsewhere alread , and said that had been there for a couple days) ????  cath flo  source??  

 

The big thing is;  he returns to the hospital on 10/13 with diagnosis of chest pain, ventricular arrythmias has peripheral i.v.'s for the stay.   They call me to come start a  peripheral line because they cant get one.  His current I.V. just above antecubital in the right side appears to be infiltrated with significant edema in arm.  He was discharged yesterday  and today I hear from one of the OR/Home health nurse  that he had a DVT in the right arm.

 

I pull up the ultrasound report done on 10/16  and the impression is  "thrombus within the right basilic and cephalic veins".

 

So.......do you think this is picc related?   I  am wondering why 10-11 days after picc line removed he develops the edema?,  no signs of circulatory changes while picc line in.  Did it take a while for the thrombus to get large enough to cause the circulatory impairment???    

 

could you please share with me any input???      Thanks,  Gina Ward R.N., C.P.A.N.

 

 

 

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From: [EMAIL PROTECTED] on behalf of Michelle Hansen
Sent: Thu 10/19/2006 8:41 AM
To: Laura Cook RN; Lynn Hadaway; [EMAIL PROTECTED]
Subject: Re: reverse tapering

I love the reversed tapered catheters!  In my opinion it does prevent a
whole lot of bleeding at the insertion site and allows us to place a
bio-patch on at the time of insertion.  If the patient has a lot of
bleeding at the time of insertion, then we gauze.  We have not had an
increase in phlebitis or DVT's.

Michelle Hansen, RN
Northeast Baptist PICC Nurse
office 297-2422
pager 235-9779

>>> "Lynn Hadaway" <[EMAIL PROTECTED]> 10/18/2006 2:52 PM >>>
I am not aware of any studies on this design feature. This feature
was added a few years ago by many manufacturers based on the fact
that there may be some bleeding immediately after insertion. As far
as I have seen, this is a design feature that is also a marketing and
sales tactic but there is no clinical evidence to support pro or con.
If someone knows of something that I don't, please share it with us.
Lynn

At 3:58 PM -0400 10/11/06, Laura Cook RN wrote:
>Does anyone know if there are any studies out here on reverse
>tapering of PICC lines and an increase incidence of DVT's?  If a 5
>french PICC tappers to 7 french at the hub.....wouldn't the patient
>be more likely to develop phlebitis?
>
>Any thoughts on this?
>
>
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--
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



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