Undetected DVT in Skilled Nursing Patient – Nurse Clinicians in Action – 37

Undetected DVT in Skilled Nursing Patient describes how an elderly patient in a Skilled Nursing Facility needed a replacement PICC line so he could complete his course of antibiotics and hydration, but the arm where the previous PICC was placed was swollen and red.

Undetected DVT in Skilled Nursing Patient

– Clinical Case

An elderly wheelchair-bound patient had returned to the Skilled Nursing Facility from the Hospital where he had received a PICC line to treat a urinary tract infection and dehydration. The PICC line had been removed accidentally prior to discharge from the hospital, so he needed new vascular access upon his return to the Skilled Nursing Facility to continue receiving antibiotics and fluids for a few more days. As such, the facility contacted Vascular Wellness and ordered a PICC line for the patient.

The vascular access expert nurse clinician arrived at the patient’s bedside a short time later and reviewed the order and medical history, noting that the PICC that had been removed in the hospital had been placed in the right upper extremity. The patient explained that his right arm was extremely sore and sensitive to the touch and begged her to not touch that arm. The clinician saw the redness and swelling when she arrived and assured him that she did not intend to perform a procedure in that arm. She also explained that she wanted to conduct a visual assessment of the affected arm because she was concerned about the presence of redness, swelling, and discomfort from the middle of his forearm to the top of his upper arm, and he agreed.

Undetected DVT in Skilled Nursing Patient

– Diagnosis and Treatment

The vascular access nurse clinician conducted a gentle but thorough patient assessment. Drawing on her extensive training, knowledge, and experience in vascular access procedures and potential complications that could arise, the Vascular Wellness expert clinician believed she saw a possible deep vein thrombosis (DVT) in the right upper extremity where the PICC had been.

The clinician was also very familiar with the risks and contraindications when a DVT is present and knew that if a DVT is present in one arm, the affected arm is contraindicated for additional vascular access, and there is an increased risk of DVT in the opposite arm if a new vascular access line is placed in the opposite arm.

After completing the visual assessment, the Vascular Wellness clinician called the patient’s nurse and nurse manager to the room to show them the patient’s upper extremity, and to share the reasons for her suspicion of the presence of a DVT. Because of the swelling, redness, and pain, the clinician recommended that the patient be evaluated with a Doppler ultrasound to rule out a possible DVT prior to another PICC line being placed in the opposite arm.

In the meantime, the patient still needed vascular access to complete his treatment. The clinician reviewed the medications and concluded that a peripheral IV (PIV) was clinically appropriate for the treatment plan and that a PICC line would not be needed. She recommended that she place the PIV in the opposite arm so they would have access and that it would not pose a risk to the patient. The staff agreed, and the PIV was placed quickly and easily.

The following morning, the Skilled Nursing Facility nurse manager phoned the Vascular Wellness Vascular Support Team call center (VST) to share that they conducted a Doppler ultrasound assessment and confirmed that the patient had a DVT in his right upper extremity. The nurse manager wanted to personally thank the clinician for her great assessment skills and explained that if the clinician had not shown them what she had observed and suspected during her patient evaluation, they never would have known the patient had a DVT. The facility and staff were in deep gratitude for the time, effort, and skillset that the Vascular Wellness vascular access clinician shared with the patient and the care team.

Vascular Access Experts

– Key Points

As Vascular Access Experts, our clinicians are not only trained and precepted in placing Ultrasound Guided PIVs, Midlines, PICCs, and Small and Large bore lines but also in identifying contraindications and comorbidities during physical examinations and medical history reviews. This deep skillset enables our clinicians to help recommend the most clinically appropriate line, which is evident in this NCIA case.

Having a clinician who is able to pivot when a prescribed line can be downgraded or advanced means that your patient can receive prompt care in place, reducing patient complications, avoiding transportation costs, and allowing your medical team to focus on their field of practice.

Our Vascular Access Specialists are Vascular Access Board Certified (VA-BC) and semiannually skill-verified to ensure we consistently operate at or above industry standards for patient safety, documentation, and evidence-based practices. We have a Director of Research and Development who is responsible for keeping our employees current on the most recent clinical practice guidelines for vascular access and helps continually improve and advance our vascular access services. We actively participate with AVA, INS, CDC, IDSA, Nursing License Boards, Hospital Boards, and The Joint Commission and are known as subject matter experts.

Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician, as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA (Health Insurance Portability and Accountability) compliant communication app. In addition, our extensive training program and diverse client base, including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities, provide our clinicians with a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.

If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, Oklahoma, South Carolina, and Virginia; and
(2) Customized vascular access services to Arkansas, Delaware, Georgia, Mississippi, Pennsylvania, Tennessee, and West Virginia; and
(3) Support vascular access services to Ohio and Kentucky.