whilst reviewing HAT - I see, and have seen over the years, many thromboses due to lines.

these are often in patient who cannot receive pharmacological prophylaxis  not always

Before I do some further research I thought that Id ask the group the question:

1. do you have many 'provoked' VTE due to catheters?

2.  are you doing any intervention to reduce this?

Thank you in advance 

Hello Sue

Since March 2022 I could only find 2 HATs reported

Patient admitted with Pancreatitis and gallstones developed extensive left arm DVT and bilateral PEs - it was due to 4 peripheral cannulas (not PICC lines) and recent pregnancy see quote from incident report "Recent Lap Cholecystectomy (3/52 ago) in SMH. Had 4 canula in left arm, says one was left in for 6 days and when taken out was very hard and painful"

DVT left arm: C5 ASIA A, chest infection, admitted to ITU and the national spinal cord injury centre. The investigation report does not mention lines but being in ICU is likely patient had lines, do they use PICC lines in ICU? maybe just central lines?

In terms of VTE prevention - which is what only my role covers, we are not doing anything specifically for patients with lines to prevent VTE other than what we do for all other patients

Not very helpful, sorry!

I can look further into these cases if you want, but due to time constraints I will wait to hearing from you if you need more information

Thank you so much for all your hard work!

Hi Sue

Hope you are well. Nice to see you in the meeting yesterday.

We don't include arm DVT in our HAT investigations as these clots are not associated with lack of mobility as DVT and PE are.

So they are not deemed to be preventable at our Trust.

Hope that helps.

Jo

thank you Joanne, and i can understand your rationale

We do record as HAT as not all PICC lines get them and there is discussion re how to prevent onn the internet - work in progress - but I feel that it is important to record for data purposes if nothing else

Thanks for raising this. Yes, we do see some catheter-related VTE cases, especially in higher-risk patients. We’re trying to reduce them by improving line care and reviewing how long catheters are kept in place.

Dear Sue,

Thank you sue for this to discuss. Of course there are many PICC related thrombosis in our trust too. There is no such guideline that could be prevented. Definitely proper PICC  line  care, regular flushing with heparin and monitoring of PICC arm (DVT sign and symptoms) practices will minimise the risk but can not prevent the clot. We record as PICC related HAT. 

thank you Urmila, so please that I'm not an outlier

when one looks at the evidence - there is no clear guidance - but we should be doing all we can - as you allude to