Published Jul 3, 2009
Looking for some info from the experienced PICC nurses. Patient has a high INR (above 3.0), MD wants line placed for long term antibiotics and dehydration treatment. MD believes since PICC line is placed in arm the INR doesn't matter (It is placed periperally). Patient is still at a higher risk for bleeding!!! I refused to place PICC. Now MD is looking to have interventional radiology place PICC in patient. Would a interventional radiologist do this??? Even with the INR that high???? Please give me your feedback.
Pt's with high INR's,low PLT's,on an anticoagulant gtt,in DIC,etc are certainly at higher risk for bleeding from a stick. However,the thing to keep in mind is the location of the vessel to be cannulated. Arm veins are easily compressible,versus deep veins like the subclavian and therein lies the difference. IR dept's tend to prefer that INR's be lowered before doing their procedures,and rightly so,because an arterial stick or traumatic complication would be catastrophic.
High INR's are not an absolute contraindication for a PICC. Choose your site well,make one stick,minimize tourniquet time,skip or minimize the skin nick,etc. The site may ooze a little more than others but that can be taken care of easily. The only thing that I would do different from my usual procedure is to open an extra box of 4X4's to start.
Can't recall where I saw it,but there was an article published within the last year that tracked outcomes for PICC placements relative to INR's...gist of the results were minimal number of complications,mostly just a few oozy sites that needed a dressing change.
One thing I try to impress on new PICC nurses is to approach EVERY pt as if they had an INR of 10,PLT's at 10,WBC's at 0.10--no margin for error with ANYONE--and things go better.
INR of 3 is therapeutic for so many patients.
iluvivt, BSN, RN
Yes...agree with above...we do it ALL the time...now a percutaneos placed IJ or Subclavian CVC is a different story..b/c as stated it is in an area not easily compressed...we make a pressure dressing...and monitor closely...we often have to apply some D-stat for 24 hrs on some of our leukemia patients
Another agreement with the last 2 posts. In fact I just, this week, inserted a PICC on a person who was at 5.4. Barely bruised. Of course, the brachial vein wouldn't be top choice on these people!
I'm more concerned with low platelets than PT/INR, I've had to turn away someone, who was a walking bruise, with platelets of 4. Usually we make sure people with very low platelets receive a top-up first.
As stated, it can be much safer to insert a PICC in some-one who has high anti-coags, than a jugular or subclavian.
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