PICC lines in the U.S.A. and the World

  1. Members--

    Over the last nine months, I have been working on a capstone project regarding PICC lines.

    I would appreciate hearing from members from various regions of the county (and please identify where your are from) i.e., north, east, south, west, and central, along with members from other countries. What I am looking for specifically is: Are you using PICC lines? Has your use increased in the last two years? Who is inserting your lines--IR, PICC team, etc.? Have there been any changes in re-insertions or infection rates? How soon after admission do patients receive a PICC line? Do you have any particular assessment tool in use for PICC line candidates?

    Thank you all so much for your input.

    AZMSNnurse
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  2. 14 Comments

  3. by   deeDawntee
    I don't go back to work until Tuesday, I will ask someone on the team who inserts PICCs your questions and I will respond in a few days.
  4. by   scrubing77
    At my place Chicago (Central) IR dose them and for the most part they are put in with in a few days 3 or so days after admission for patients who have no other access and have very bad veins where now one can get them.
  5. by   UM Review RN
    Florida here. Lots of elders with frail veins. We have a lot of PICCs.

    We do have a screening tool around our place somewhere, but most of us have it memorized. It has something like, how hard a stick, how many sticks needed, what type of IV meds are being given and for what duration.

    We put in a consult to the IV team for reseals that we cannot get, and they'll sometimes recommend a PICC.

    We do most PICCs with the IV team via US at the bedside, but some are done in Radiology if the IV team has a hard time.

    I'm not sure about infection rates.
  6. by   TheCommuter
    Quote from AZMSNnurse
    Members--

    Over the last nine months, I have been working on a capstone project regarding PICC lines.

    I would appreciate hearing from members from various regions of the county (and please identify where your are from) i.e., north, east, south, west, and central, along with members from other countries. What I am looking for specifically is: Are you using PICC lines? Has your use increased in the last two years? Who is inserting your lines--IR, PICC team, etc.? Have there been any changes in re-insertions or infection rates? How soon after admission do patients receive a PICC line? Do you have any particular assessment tool in use for PICC line candidates?

    Thank you all so much for your input.

    AZMSNnurse
    1. I am located in North Central Texas (some people think Texas is in the South, and other people think it is in the West). More specifically, I am in the Dallas-Fort Worth area.

    2. I regularly use PICC lines.

    3. The use of PICCs has increased, especially considering the fact that I work in on the SNF/rehab unit of a nursing home.

    4. The pharmacy that delivers our meds also has a PICC line team of nurses that insert all of our PICCs. We must call them if we wish to have a PICC placed.

    5. PICCs are typically inserted within 48 hours of admission at my workplace.
  7. by   AZMSNnurse
    I would be very interested in obtaining a copy of the assessment tool if you can locate one. It sounds like it includes most of the questions I have put in the tool I am designing, but I am always looking for more info. Thanks!
  8. by   sonja77
    i live in north east texas and so far i've never even seen a picc line!

    but i do know that there is supposed to be at least one nurse in the hospital or on call who is able to insert a picc line.

    if we have a pt with "bad" veins, one of the surgeons will put in a central line; usually in the subclavian (1st choice) or femoral (2nd choice) vein.
    if a pt will need long term iv therapy, they'll put in a groshong.
  9. by   AZMSNnurse
    i thank those who have taken their valuable time to reply to my post.

    i would still like to hear from others in various parts of the country/world.

    thanks so much! nurses rock!
  10. by   miko014
    I'm in the midwest. We use PICCs all the time. There is no specific assessment tool that we use, it just has to do with how hard of a stick the pt is, etc, and of course what meds they are getting. We also use a lot of groshongs and IPs, but I would say PICCs are way more common than central lines where I work. We have an IV team that does our PICCs at bedside with US. They are there from 9am to 9pm. If it's after 9pm and a pt can't wait until the next day for access, they will put in a central line. Sometimes the positioning isn't right with the PICCs and they will use them as midlines instead. Uh lets see what else - oh, we use douible lumen power PICCs (no sutures with our PICCs). As far as infection rates, I don't know that data off the top of my head. I can't think of anything else about them right now...
  11. by   deeDawntee
    Hi Minnesota here.
    At my facility we use Power Piccs and a stat lock system to hold it in place. PICC use is common and the people I have asked believe we are using them more and more. (because many of the Physicians do not like to put in central lines) The PICC lines are placed by 1) CMT (Clinical Monitoring Team) these are people who are experts on all lines, including hemodynamic lines (they will go into the OR to help place art lines and CVP set-ups etc.) IABP's, ultrafiltration, Arctic Sun, etc. 2)Specially trained nurses on the IV resource team, 3)IR underfluoroscopy for when PICC lines have not been able to be placed at bedside.

    Our infection rate in all central lines are down.

    There is no assessment tool. PICCs are placed if the patient needs pressors or TPN/lipids, longterm abxs etc.
  12. by   anc33
    PICCs were very common at the hospital when I worked on the floor. We had a team of 4 PICC RNs who placed the lines at the bedside. The patients would then get a portable CXR and the line would be adjusted by a floor RN and the CXR repeated. We worked very hard on our PICC protocol and the infection rates were very low. Even in patients who had these lines in for numerous months. They hardly ever used central lines, only in emergencies and then only for a couple of weeks or less.
  13. by   woody62
    I do not work but I have had two PICC lines over the past ten years. Both were put in by a team of nurses. I had mine put in because I required more then a month of IV therapy. My first was inserted at the bedside and took several attempts before they were successful. My second one was also done at the bedside, but with the use of an ultrasound, which made it much more successful when it came to placement. I had chest x-rays following both.

    The funny thing, my daughter developed a chronic wound infection. She was treated by the same ID doctor as I was. She did not put a PICC into her, saying that she was more likely to suffer a phlebitis. So, every day for more then six weeks my daughter had to go in and have an stick done. They wouldn't even put an indwelling catheter in her.

    Woody
  14. by   RNAnnjeh
    Hi,

    I'm in Eastern Canada. Currently, there is a program in place aimed at improving patient safety called Safer Healthcare Now! One of the target areas is central venous access devices (including PICCs). Visit http://www.saferhealthcarenow.ca/ for information on the project and what is happening with central lines.

    I can tell you that at my hospital, PICCs are placed by a MD----we have 1 pediatrician who does them at the bedside, 1 general surgeon who does them in the OR....not sure about the intensivists. The NNPs can do them in the neonatal population.

    Hope this is helpful.

    RNAnnjeh

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