PICCS and DVTS

[beaglelover]

I would love some feedback please on a situation. An elderly man was readmitted ( sent out for pneumonia) to our LTC facility Sat afternoon with a PICC in his right arm. It was assessed to be intact, no c/o pain from pt, no swelling. An order was received to D/C the PICC Sat.,( he wasnt my pt), his nurse asked me to look at it. Pt c/o a lot pain in arm, he was resistant to straightening it. MD called to d/c line and get a venous doppler. Also, I measured 11 cm of a swollen are at the PICC site We could not get anyone to come out to do the doppler, MD ordered pt to be sent out. My question is how long can it a take to develop a DVT, if he was seen Sat pm without pain or swelling to PICC area and it was observed Sunday evening Thanks!!!

[cbc nurse]

Hi

I am an oncology nurse in Uk, so forgive me if I do not understand all your terminology! I have known DVT to develop visible signs overnight, although it usually shows signs the day before. Did he have a chest Xray to guage tip position? Could blood be aspirated from line? Had he knocked it or fallen? infection?? What happened to him?

In UK, in this instance I would have told the patient to apply heat 20 mins tds and take Brufen or similar anti-inflammatory drug, but would have got him back for urgent doppler assessment. I would have been very unhappy to discharge him as potential upper vein DVT usually get admitted in Uk until confirmed or disproved.

[PICC chic]

It has been my experience that DVT's can become noticable from one day to the next. Usually the blood slowly begins to adhere to the outside of the PICC and continues to adhere until blood can no longer pass between the catheter and vein wall and viola the arm begins to swell, and if the patient has thin arms it becomes noticable quicker.

[PICC ACE]

PICC's can start to get a build up of fibrin from almost the moment they're placed,and depending on the source you find,up to 60-some % of PICC's develop some thrombus on them,though most are never symptomatic. The fastest I've ever seen one get symptomatic was on a patient that had a line put in Saturday evening and by Monday morning the arm was swelling. I could see the clotted off vein with my bed-side US and this was confirmed by a Doppler in Radiology. This was an unfortunate outcome,but the PICC inserter used very poor judgement in catheter,site and vein selection. This was a 6-Fr line placed into the radial vein below the ACF--all factors that contributed to a higher risk for DVT formation.

[LoveTheNICU]

Back in the day... when I was the patient and not the nurse, I had a PICC that developed a DVT. The line was place on a Friday about 1300 and I started noticing heaviness, pain and stiffness on Sunday about 0200... It took them until Monday at about 1100 to believe me that there was a problem(I wasn't very old, but very in tune with my body), because I had not visibly begun to swell. Of course, when someone woke up and paid attention, they ordered a STAT doppler and pulled the line. Dx? Thrombus at the catheter tip. I was heparinized and told to avoid PICCs in the future, which was bad news for a kid in a chronic illness state... it was back to a life of PIVs.