Nancy, I had a question for you and was wondering if you could give us some insight. I have always been told that we should not stick extremities with limited mobility or sensation, whether it was due to stroke or spinal injury. Lately we have had MD’s ordering PICC lines on these patients, most recently a quadriplegic patient. We said no and they are asking for supportive documents. We searched INS and it looks like it only mentions contraindications for PIV and strokes. Do you have anything either way to support our or their position? Brad M.
That’s a tough one. The issue of contraindication is never absolute, individualized per patient and as such I know of little literature to support not placing a PICC in a patient with circulatory compromise. As always our education should be updated with research. It is true indications and contraindications focus on healthy veins with good or normal circulation. I was able to find a retrospective study that indicated that there was no increased risk of DVT with quadriplegic patients. I would suggest you do your own study as you begin to use PICCs with this higher risk population and determine if a greater number of complications are or are not occurring. — Nancy Moureau
Link to Ref: Loupus D, Schuetrumpf S, Vazquez LF. A retrospective review of peripherally inserted central catheters and upper extremity deep venous thrombosis in persons with cervical spinal cord injuries. The Journal of the Association for Vascular Access. 2008 Jan 1;13(2):82-7.