Step 3 involves a four month audit of dressing and securement. Step 6 requires a four month audit of line necessity. To facilitate both of these audits during a single four-month time frame, we recommend using the below audit form. 
​Securement: if a PICC is in place, appropriate care/maintenance must be in place
Element
Key Institutional Partners
  • Dressing audits should be performed to examine whether site is clean, dry, intact and the catheter is appropriately secured
    • Movement of the catheter at the exit site (“pistoning”) can induce endothelial injury and promote phlebitis which can cause thrombosis
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
  • Ensure competencies of nursing staff are up-to-date for catheter care and maintenance
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
  • Measure external catheter length and document in chart
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
  • Review periodicity and compliance via audit of charts of patients with and without thrombosis
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
  • Consider use of advanced securement devices
    • StatLock
    • Secureacath
    • Sorbaview
    • Other adhesive or advanced devices
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
​Resources/Tools
I-DECIDED PICC Assessment and Decision Tool for Nurses
Catheter Dressing and Securement Audit Form
Care and Maintenance Handout for Nurses
Articles/References
​Zehnder J, et al. Catheter-related upper extremity venous thrombosis. Up To Date 2018 
  • Intravenous catheters cause endothelial trauma and inflammation that often progresses to venous thrombosis. Three-quarters of thrombotic events occurring in veins of the upper extremity are due to the presence of intravenous catheters. This article provides a detailed summary of the available evidence for detecting, identifying, and treating upper extremity deep vein thrombosis
Validation Survey
DVT Step 3 Validation - Care and Maintenance - Securement.
  • This document includes all of the validation questions associated with this content area to help with collaboration on responses for your hospital. Responses to the validation questions should be entered in to the linked document and recorded to monitor progress.
Use of systemic anticoagulants for prophylaxis is not recommended to prevent PICC related upper extremity (UE) DVT
Element
Key Institutional Partners
  • Use of systemic anticoagulation at prophylactic doses (e.g., low-molecular weight heparin [LMWH] or Heparin VTE prophylaxis) does not lower risk of PICC-related thrombosis
Providers
  • Do not use or expect systemic anticoagulation to reduce risk of DVT
Providers
  • The role of aspirin in preventing catheter-related thrombosis (CRT) is not clear
Providers
  • Limit/Avoid Blood Transfusion via PICC
Providers, IR, Vascular Team
Articles/References
​Zehnder J, et al. Catheter-related upper extremity venous thrombosis. Up To Date 2018 
  • Intravenous catheters cause endothelial trauma and inflammation that often progresses to venous thrombosis. Three-quarters of thrombotic events occurring in veins of the upper extremity are due to the presence of intravenous catheters. This article provides a detailed summary of the available evidence for detecting, identifying, and treating upper extremity deep vein thrombosis​
Rogers MAM, et al. Association between delivery methods for red blood cell transfusion and the risk of venous thromboembolism: a longitudinal study. The Lancet Haemotology 2016
  • Red blood cell delivery through a multi-lumen PICC is associated with a greater risk of thrombosis than transfusion through a peripheral intravenous catheter. Careful monitoring for venous thromboembolism when transfusing red blood cells through multi-lumen PICCs seems necessary
​Patient Education regarding care and maintenance of PICC line 
Element
Key Institutional Partners
  • Educate patients regarding precautions they need to take while the PICC line is in place including no lifting heavy weights, no contact sports, avoid lifting the arm above your head, and monitor the catheter length on the skin
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
  • Educate patients on PICC care
  • Evaluate when patients are being educated and ensure that education occurs at a minimum prior to/upon PICC insertion and upon discharge if the patient is being discharged with a PICC
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership
​Resources/Tools
​I-DECIDED PICC Assessment and Decision Tool for NursesPatient Education Tool on Protecting the Arm and PICC
Patient Education Tool on Caring for PICC  
Patient Education Care & Maintenance Guide: “Your Peripherally Inserted Central Catheter”
Giving Medication by IV Push Home Care Handout
myIV.com
Validation Survey
​DVT Step 3 Validation - Patient Education.
  • This document includes all of the validation questions associated with this content area to help with collaboration on responses for your hospital. Responses to the validation questions should be entered in to the linked document and recorded to monitor progress.