[blsmom]

Am I correct in saying that a triple lumen power picc has a higher incidence of DVT risk? What are the risk factors associated between the 5 FR. size double lumen vs the 6 FR. triple lumen cath?

Thanks in advance!

[CritterLover]

Risk of DVT is always going to be higher with larger size (french) catheters, be it picc, tlc, cordis, whatever.

I don't have the actual numbers for the power picc, since we don't use Bard products where I work, but your Bard Rep should be able to give you that data.

[PICC ACE]

There is conflicting data on catheter size and thrombus development. There are many other variables than cath size at play,to wit vein size,basilic vs cephalic vs brachial,left vs right side,above versus below the ACF placement,tip location,platelet levels,presence of solid tumors,and some people's innate propensity to get clots around their catheters. There's a lot more to it than just size. The biggest risk is often in poor vein choice--whatever size device you use,if you try to put it into a vein that is too small relative to the size of the catheter,you're asking for trouble.
Happy PICC'ins.

[kaedawn]

Appreciate your response re: clots and size of picc lumen used.

Working part-time infusing biologics in Colorado office. Opportunity to work in Infectious Disease practice additionally, but need PICC certification.

All ideas welcome - please recommend good starting point for training in PICCs & Midlines.
Thank you!

[iluvivt]

Agree with PICC ACE there are a lot of variables. What I do before I place any PICC is to evaluate the situation,review the chart and speak with the nurse. Then I place the most appropriate catheter that will meet the pts needs. Sometimes I can determine that the pt will have an increased risk for throbosis and then our team will increase our monitoring. Recently,clinicians in Italy put a wonderful consensus paper together after reviewing all current and pertinant literature and research, The single most important factor determining an increased risk of thrombosis related to a CVC is where the tip of the catheter is located. We have known this for a long time. The further you gaet away from the distal superior vena cava the greater your risk. So,if the tip of the CVC is in the subclavian vein your risk is greater and can be as high as 60%.The importance of getting and then keeping the tip of the catheter in the low SVC can not be stressed enough. of course there are situation b/c of anatomical or pathophysiologic reasons a catheter will not advance to the SVC sometimes we have no choice. Clinicians must always look at risk vs benefit. hope this helps

[jujujor52]

I have heard that the INS standard is saying that is OK to leave a PICC line in the Mid-clavicular position. Does anyone know if this is true?Please put your two cents in.

[IVRUS]

Originally Posted by jujujor52

I have heard that the INS standard is saying that is OK to leave a PICC line in the Mid-clavicular position. Does anyone know if this is true?Please put your two cents in.

NO... When you read the standards, it will be quite evident that whoever told you this, spoke in error!
INS only recognizes two tip locations for peipherally inserted IV catheters over 3" in length:
1. A Midline (which is 3-8 inches in length and whose tip terminates before the axillary vein in the upper arm)
2. A PICC ( which is a centrally placed IV catheter whose tip should terminate in the distal SVC)
Midclavicular placement has an much greater increase in Thrombus and has not been recognized as an option for tip termination in years.
DD