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!

[Been there,done that, ASN, RN]

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?

In this case neither arm is IV accessible. One would hope the docs would have put that together.

Inform the attending , obtain the appropriate order, Stop taking responsibility for the provider.

[VANurse2010]

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.

The other concern is that if the IV fluids infiltrate, then the patient doesn't have the lymphatic drainage system to clear it.

[ixchel]

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.

Agreed!!! And I would hope the MD is nearby and accessible (even more hopefully PRESENT) for that considering it's an active attempt at possibly moving a clot into the central circulation.

Honestly, this is something we would run a heparin drip until interventional cardiology assessed to determine if this could be cathed. Absolutely no procedures would be done by nursing on the affected side, short of assessment and pain management, reporting changes in status immediately.

NOT avoiding that arm can lead to infiltration, evisceration, infection, edema (severe enough could lead to compartment syndrome, although hopefully it's being paid attention to frequently enough it didn't come to that), moving the clot into central circulation, and I'm sure plenty of other icky things.

No no no!!!

[MunoRN, RN]

You shouldn't place a new PIV in an arm with a DVT, but it's worth clarifying that it's not actually generally considered to be good practice to remove a PICC in an arm with a DVT just because of the presence of a DVT.

[iluvivt, BSN, RN]

Contrary to what many think using the ACF for routine IV therapy is not a good plan. They should be considered blood drawing veins and may be used for very short periods of time such as a need for a power injection and urgent IV access. They have a very high rate of thrombosis if left in place for days and especially if used for medication and solution with high osmolalities. We added to our policy that PIVS in the ACF must be re-sited as soon as possible. If this can not be done it is a great time to assess the veins, the prescribed therapy and determine the most appropriate VAD to use.

My hope is that IV teams will be utilized more. Hospitals that have reduced their IV teams have seen an increase in their PICC and CVAD placements so the right line in the right patient at the right time is not going to happen unless the resources are available!

Thank you Muno, many think if you have a superficial vein thrombosis or DVT if in the Basilic vein you pull the line...not true. It also depends on the type too, occlusive versus non-occlusive and whether the patient has symptoms or not. If you were to order a doppler on every patient with a CVAD I think we wold be surprised to find more thrombosis than expected.

[ixchel]

This image shows why pulling a PICC should be reconsidered carefully. Any infusion flowing through it goes into central circulation (hence, peripherally inserted central catheter). If the clot isn't in the vein of the PICC (usually basilic), the PICC should not cause complications.

[iluvivt, BSN, RN]

It also depends upon the type of clot..occlusive versus non-occlusive. We do not perform dopplers or other tests on every patient with a central line. Many have clots that we are never made aware of and they remain clinically silent.

[BuckyBadgerRN, ASN, RN]

Is that arm the ONLY choice for IV placement? I'd stay as far away from it as possible, but maybe that's just me!

freezin said:

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!

[IVRUS, BSN, RN]

MunoRN said:

You shouldn't place a new PIV in an arm with a DVT, but it's worth clarifying that it's not actually generally considered to be good practice to remove a PICC in an arm with a DVT just because of the presence of a DVT.

You are correct. As long as it is not thrombosed and infected, anticoagulate the line and restore its patency.

[DrVen1]

Interesting