Tourniquets for PICC Fracture

In the past I've heard that when a PICC breaks, one should apply a tourniquet to the affected extremity with the PICC to prevent a segment of the catheter from moving into the patient circulation; yet I've also heard this can be dangerous and is not evidence-based. My organization is also considering implementing this as a practice. Any sources to share on that?

All I can share is the rationale for this practice and when I think it is best to use. When the nurse suspects that a PICC has fractured, a tourniquet should be placed high on the extremity. The reason is so that compression from the tourniquet will prevent the fractured PICC from embolizing to the right heart or pulmonary artery. A simple cutdown procedure on the extremity is far less invasive and risky than a large-bore snare device inserted through the femoral vein and advanced to the right heart under fluroroscopy in the hopes that one can snare the fracture catheter and remove it.

This tourniquet should not be tight. You should always be able to feel the radial pulse with application of any tourniquet as you are not trying to cut off the arterial circulation. This tourniquet should not be removed and the patient needs immediate diagnostic and surgical services to locate and remove the catheter fragment from the extremity.

If the nurse is not present when the fracture event is suspected, a tourniquet probably will not do any good. For instance, if the patient is flushing the catheter at home and feels something "snap", the chance of successful application of a tourniquet is very low. By the time the nurse gets to the patient or the patient gets to an ER, the fractured catheter has already embolized.

So it really is a decision based on the specific situation for each patient. If there is anything that can be done such as a tourniquet to hold the PICC in the extremity, that is the goal. Of course, it may be far too late by the time the nurse is present.