A PICC line requested has been received for a 17-year-old male patient with cystic fibrosis on unit 3 North. You review the patient's medical record and his complete blood count shows a white blood cell count of 7.8, hemoglobin 11.5, hematocrit 32.9, lymphocytes 0.4%, and platelets 450. You notice he recently completed a 3 week regimen of Lovenox and his INR is currently 2.0. After reviewing the patient's medical record, you go and discuss the procedure to the patient. You noticed the patient's arm bruised with intravenous catheter with normal saline infusing in his upper arm that was inserted last night.
Based on the scenario above, how does this patient's lab results play a role in your decision to place a PICC line? Explain the reasoning related to the lab result(s) which are critical in making this patient eligible for PICC line insertion. How does the patient's bruising and previous intravenous catheter factor into the PICC line insertion?
When determining whether or not the patient qualifies for a PICC line, a complete review of the patient's lab results is required to determine the patient's overall health. Specific lab results of significant importance are the patient's white blood cell count which would identify if the patient is experiencing any type of infectious process and clotting status of the patient. Determining the patient's clotting status is typically determined by reviewing the patient's platelets. Normal platelet range for patients is 150-450. Due to the cystic fibrosis patient receiving Lovenox, his INR level is also significant as this also provides indication of patient's normal clotting time. Normal blood clotting for patient receiving anticoagulants like Lovenox is between 2.0-3.0. Based on the patient's lab results, he is a candidate for PICC line insertion for long-term antibiotic therapy. Bruising on the patient's arm is not of significant concern for PICC line insertion. Post-insertion, the patient's bruising would need to be documented to include shape of bruising, color, length, and/or circumference of bruising. This will assist the PICC nurse and other healthcare professionals with monitoring for any post PICC-related complications. With regards to the IV catheter insertion last night, I would not discontinue the IV until successful PICC insertion and clearance to use the line. However, should the arm be utilized for PICC insertion that has the IVF infusing, the IVF would need to be stopped during the PICC insertion due to requiring occlusion of the vein for appropriate vein selection.