Paper
Saturday, July 14, 2007
Effects of INR levels on Bleeding Occurrences during the first 24 hours of Ultrasound Guided PICC Line Insertion
Linda Daniels, RN, Nursing IV team, Lankenau hospital, Wynnewood, PA, USA and Margaret Oldham, RN, MS, Nursing PICC Team, Lankenau Hospital, Wynnewood, PA, USA.
Because of concern regarding the bleeding risk, insertion of Peripherally Inserted Central Catheter (PICC) in patients with INR levels greater than 1.5 was delayed until INR levels decreased to 1.5 or less. Coumadin was held and patients often received Vitamin K or Fresh Frozen Plasma. A decreased INR increased the risk of blood clots and possible CVA or Pulmonary Embolism. A literature review revealed no previous studies regarding the effect of INR levels on bleeding during PICC insertion. Physicians often requested that the PICC line be placed even though the INR was greater than 1.5. PICC team nurses and physicians agreed that data needed to be collected to determine a safe INR level for PICC insertion. One of the PICC team nurses attended a class offered at the hospital to learn the components of a research project. The PICC team met to determine what data needed to be collected and a data collection instrument was developed.
Subjects: 127 subjects with an INR 1.5 or greater at PICC insertion were observed for bleeding at insertion and for 24 hours post insertion. Results: Over 60% of patients experienced no or mild bleeding at insertion. For an INR less than 3.0, fewer than 10% of the sample experienced moderate bleeding within the first 24 hours. No PICCs were discontinued due to bleeding. Results suggest that INR levels below 3.0 did not appear to have an impact on amount of bleeding during PICC insertion. At 24 hours, INR levels of 3.0 and above did appear to have an impact on the amount of bleeding.