IV starts in arm with a DVT

[freezin]

Is it ok to start an IV in an arm with a DVT? And, if it is ok, is there any reason not to run heparin into that IV?

There has been a little controversy over this at work.

Thank you!

[NanikRN]

Why would one possibly want to start a IV in an arm with a DVT? I cant imagine a good reason

[Ndy-RN]

Nooooooooo not good practice at all. Why would someone even think that ...common nursing sense people.

[Karou]

No, a known DVT in an upper extremity is a contraindication for IV access. Once a DVT is discovered we have to remove any IV access (PIV or PICC).

The arm already has a DVT and is at risk for further neurovascular compromise. You should not to anything else to that extremity that could cause neurovascular damage- so no IV's, blood draws, or blood pressures.

That is what I have been taught and that's the policy where I work.

[calivianya, BSN, RN]

Agreed with the others - you should d/c any access in that arm unless the physician specifically wants an IV in that exact vein to run tPA right at that site. I have seen that done before but it is not usual practice.

[IVRUS, BSN, RN]

If the patient has a confirmed DVT in one arm, the circulation in that arm is already impaired, so why, oh why, would someone put a line in that exact arm? It is never a good idea. Heparin ran through a different extremity, or through a physician placed Central Line,would be the best option.

[freezin]

Thanks for the feedback. Plenty of patients come in with IVs on the DVT side due to other complications such as a fistula or mastectomy on the opposing side. Perhaps something other than a peripheral is warranted for these patients?

[Karou]

I wouldn't say an upper extremity DVT is rare, but I definitely don't see them as often as a leg thrombosis. Is it really that common that yall get dialysis patients with a upper extremity fistula one side, and a upper extremity DVT on the other?

Does your facility have a policy in this? We do, and as soon as the DVT is discovered/known, IV access is removed (if it was already there), and that extremity is made a no stick/no BP. If a patient is like the one you described then then I have seen IV's placed in the foot, EJ, or physician places a central line. I have seen less than a handful of patients who have that exact scenario though.

If the other arm is limited due to mastectomy (w/lymph node removal) or CVA, the physician will order that arm to be used.

[brownbook]

Please educate me, what is your patient population that so many have upper extremity DVT's? What is causing this?

As Karou mentioned you can get a Dr's permission to start an IV in the affected arm of a breast/lymph node dissection or CVA patient. Our surgeon, who does 100's of lymph node dissections a month for breast cancer, said the main concern for the arm is a "dirty" cut or wound. With a Dr. or surgeon's okay using the arm for a "clean" IV start may be acceptable.

[CountryMomma, ASN, RN]

I've seen quite a few UE DVTs in our IV drug abusing folks. A few isolated hypercoagulated oncology patients.

[KelRN215, BSN, RN]

All the upper extremity DVTs I've seen have been related to PICC lines. Once the clot is discovered the PICC is removed and the arm is no line/no tourniquet/no BPs. If you can't use the other arm, use the lower extremities or have the MD place a central line. We use the feet all the time for IVs in Pediatrics.

[iluvivt, BSN, RN]

No it is not OK...once you have a venous thrombosis you should not place any VADS in that arm until it is completely resolved. It is,however, NOT a deep vein thrombosis if it is in the lower part of the arm or in the Cephalic or Basilic vein of the upper part of the arm.

These are superficial veins.The Brachial vein is a deep vein because it is paired with an artery! I see MDs and other LIPS get this wrong and it annoys the heck out of me!

Please stop this practice as it violates the standard of care.