[JEKA]

Hello all,
I am new here and this is my first post, so please forgive if too long etc. Anyway, I just recently (July) began inserting PICCs using the MST with the ultrasound at my facility. It is a small hospital and I am the only person doing it. We do have access to interventional radiology if I am unsuccessful. My question is, how do you all document and chart after you inserted the PICC. We are not computerized. I guess I am looking for exact verbage. I have been writing EVERYTHING I did from identifying the patient to inserting and removing wire, then introducer etc. I thought about just writing PICC inserted using MST but unsure if that was ok. What do you all do out there? Thanks

[IckuRN]

Our PICC nurses note location, bore and length, number of attempts, per sterile procedure, dressing type, and some blurb about why they had to do it.."per md request". Then they order the CXR, note the results.

[iluvivt]

I made a chart form for us and it includes the following.
1. MD ordering the PICC
2. Reason for insertion with procedural pause indication
3. Catheter Type,it lot number,lenght and size
4. I have check boxes for the following...Mico. intoducer technique lidocaine 1% per protocol, stylet removed intact,blood return noted,flushed per protocol
5. I have a section for arm circumference,internal and external length and amt trimmed
6 We circle the arm (R or L ) and circle the vein
7. date and time, insertor and assistant and comment section
8, Lastly, we hace a section for the nurse to read and what the radiologist read it as and any recommendations for adjustment

If you are writing everything down every time I would make a chart form. in the meantime here is the way I used to document it. Procedual pause completed and a 5 FR. 47 cm groshong PICC (lot # RESGO706) was inserted per protocol to right basilic vein using ultrasound guidance easily with one attempt. A micro-introducer was used (or you could say modified seldinger ) and it threaded easily. A sherlock tracking device was used during the insertion. The stylet was removed intact and a sterile pressure dressing was applied (or whatever you use). The patient tolerated the procedure well with no complications observed. Picc teaching was completed and pt verb understanding of teaching. (I have the teaching outlined in the protocol and the pt signs a teaching form. Hope this helps let me know

[suzanne4]

The above posts have great information, but the thing that I find most important to be included is the length of the catheter that was left in place. We all know that many times they are shortened for one reason or another, but it is not always documented. This creates a big problem for those on the the removal end of it. Adn what we hear with the most complaints about them.

Good job everyone.

[P_RN]

Great suggestion Suzanne4. Many, many years back we got a patient transferred from another state. The transfer documentation was angiocath 18g left ac space. Well in my place we never used that brand and the CNS said it's the same as a jelco (another brand name). OK so the resident writes "remove the angiocath/jelco." as there was no insertion date. The RN who had the patient started removing it, and then we got the code blue light (a button we never had seen used before). We used a telephone number to call a code.

Anyway, we all ran in there and her she is pulling what looked like a giant spaghetti noodle. It must have been 12-14" long. The CNS finally said oh **** (my asterisks).

Thereafter, we made sure that all lines length were documented. Since that time I have called other hospitals in town to as far away as Canada to get the REST of the story.

[iluvivt]

Remember not all catheters are trimmable . The dual and triple lumen open-ended catheters generally are. The 4fr. groshong can be trimmed after insertion before applying the end assembly. In our PICC form it says amt trimmed....amt inserted and amt externally visible. I did not include that in the example because the 47 cm groshong can not be trimmed. We also post a sign over the bed with this info and staple a cheat sheet to the kardex. Pts that come in with PICCs are checked by the team and x-ray is usually obtained and if all is OK we relese it for use