Re: picc line criteria
Guidelines,no. Clinical judgement,thorough assessment and evaluation of risk vs benefit,yes.
I've done PICC's for patients with platelets of 10,INR of over 7,shortly after 600mg of Plavix,on TPA,etc. Where did you get the INR of 1.7 from? Radiology? They have their "guidelines" because they are going into
noncompressible areas,a much different situation than PICC placement. If they hit an artery inside the chest or abdomen on an anticoagulated patient,that's a potential emergency. If your PICC site oozes a little more than usual,open a few more fluffs and hold pressure longer.
A skilled nurse using ultrasound and MST for PICC placement is a lot safer than the alternatives (i.e. the average floor nurses and phlebotomists and their multiple sticks on the patient or an MD using 'landmarks' for a central line).
Think of the relative risk/benefit issues. Imagine a patient with a mechanical valve,needs a PICC,INR 3.2. No CV surgeon is going to agree to risk letting the INR go under 1.7 just for the 45 minutes it'll take for a PICC to be placed.
Good luck with your new program.
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