PICC removal - page 3

by agldragonRN

14,675 Views | 55 Comments

i work ltc and my job does not allow staff rns to remove picc even if we are iv certified. the md comes and removes them. the doctor came today and removed left upper arm picc from my patient. i gave him all the supplies (gauze,... Read More


  1. 1
    Quote from katie5
    not blaming or anything, but next time, she might want to stay with the md during removal or a procedure on her patient, especially as this is ltc. doctors are few and far between, so just to keep up with the going-ons on your patient. and i'm sure the doctor would not have minded if you had requested he keep the picc line so you could measure it.

    it's team work, sometimes all this, "he should, you should, they should", not my fault, not my responsibilty just bugs things down.
    it should be " what can i do to make things better?"how can i help to make life easier?' it's more of the attitude.

    you also got into trouble not because you were wrong, but because you did not follow policy. each and every hospital has their own policy, when there is a policy, you should try as best as possible to follow it. there are rules to live by.
    nurses are spoiling the doc too much. everything is on the nurse yet the doc is the one who is making tons of money. i offered him the measuring tape and he told me he did not want to measure it and i'm expected to collect the catheter and measure and chart it? it's like some of the nurses at work who chase down the cnas to tell them a patient wants something when it could have taken half the time if that nurse just did that something for the patient.
    nursearoo likes this.
  2. 0
    Quote from katie5
    not blaming or anything, but next time, she might want to stay with the md during removal or a procedure on her patient, especially as this is ltc. doctors are few and far between, so just to keep up with the going-ons on your patient. and i'm sure the doctor would not have minded if you had requested he keep the picc line so you could measure it.

    it's team work, sometimes all this, "he should, you should, they should", not my fault, not my responsibilty just bugs things down.
    it should be " what can i do to make things better?"how can i help to make life easier?' it's more of the attitude.

    you also got into trouble not because you were wrong, but because you did not follow policy. each and every hospital has their own policy, when there is a policy, you should try as best as possible to follow it. there are rules to live by.
    i really didn't get in trouble. i was just given an "advice." and sometimes this supervisor does not know the p&p himself so i have to take his advice with a grain of salt. i looked at the p&p and there is no mention of removing a picc as staff rns are not allowed to remove it at my facility. i get the point. it is for patient's safety but if the md himself seemed not interested with the measurement why would it fall on the nurse. oh well, that's nursing!
  3. 0
    Quote from IVRUS
    I too would be worried about air-emboli while in-situ, because if you had a non-valved IV catheter and the injection cap "accidentally" came off, or was removed when the syringe was removed, air emboli is a problem and concern. However, depending on the size of the PICC, or any CVC, their could be a track through the skin into the vein that stays open once the catheter is removed. That is why it should be immediatly covered with a gel to seal the track shut. The is not only common sense, it is an Infusion Nurses Society (INS) standard.
    It should NOT, however, be used at the site for routine care.
    If you didn't follow this standard and your pt suffered an air embolism as a result of this neligence, a successful lawsuit with you being the loser will result.
    There seems to be this wave of fear-mongering lately on behalf of the INS, which strikes me as desperate attempt to force some credibility by threats where it hasn't been earned . Even worse, none of the threats seem to have any basis in reality.

    Negligence is doing something that no reasonable person in that situation would do. There are many practice recommendations, particularly from the INS, where there is no overwhelming consensus and policies may vary from one hospital to another, which means there is no basis for negligence because you followed your facility protocol rather than a moderately influential practice group's poorly substantiated recommendation.

    My facilities policy not only does not say to apply a gel after PICC removal, it specifically prohibits it. Applying a gel does not provide an occlusive seal. Imagine if you have a leak in a tire, would putting some vaseline on it seal the leak? Probably not. Another issue is safety; If there is an open track to a vein where the vein is exerting negative pressure into that track, is it a good idea to put vaseline in the track? Absolutely not, this (vaseline emboli) has been attributed to at least one death. Is the threat of air embolus following PICC D/C significant enough to support such a risk? Nope, there has never been a reported case of air emboli following removal of a PICC. Are there safer and more effective options? Yes, an occlusive dressing is far more likely to successfully occlude the opening, and it's unlikely that the dressing could be pulled into the vascular system. Occlusive dressings can be placed in one motion with removal of the PICC resulting in minimal time between removal of the line and occlusion of the tract. We don't allow vaseline soaked dressings either, these just make it more likely that the occlusive dressing will fail and provide no advantage over an occlusive dressing alone.
  4. 0
  5. 0
    Quote from MunoRN
    There seems to be this wave of fear-mongering lately on behalf of the INS, which strikes me as desperate attempt to force some credibility by threats where it hasn't been earned . Even worse, none of the threats seem to have any basis in reality.

    Negligence is doing something that no reasonable person in that situation would do. There are many practice recommendations, particularly from the INS, where there is no overwhelming consensus and policies may vary from one hospital to another, which means there is no basis for negligence because you followed your facility protocol rather than a moderately influential practice group's poorly substantiated recommendation.

    My facilities policy not only does not say to apply a gel after PICC removal, it specifically prohibits it. Applying a gel does not provide an occlusive seal. Imagine if you have a leak in a tire, would putting some vaseline on it seal the leak? Probably not. Another issue is safety; If there is an open track to a vein where the vein is exerting negative pressure into that track, is it a good idea to put vaseline in the track? Absolutely not, this (vaseline emboli) has been attributed to at least one death. Is the threat of air embolus following PICC D/C significant enough to support such a risk? Nope, there has never been a reported case of air emboli following removal of a PICC. Are there safer and more effective options? Yes, an occlusive dressing is far more likely to successfully occlude the opening, and it's unlikely that the dressing could be pulled into the vascular system. Occlusive dressings can be placed in one motion with removal of the PICC resulting in minimal time between removal of the line and occlusion of the tract. We don't allow vaseline soaked dressings either, these just make it more likely that the occlusive dressing will fail and provide no advantage over an occlusive dressing alone.
    Muno,
    I am familiar with your distain for INS, however, It IS the standard across the nation to "seal" the site with ointment and then place an occlusive dressing over the site to prevent AE. I don't believe an occlusive dressing is sufficient by itself. I've also not heard of an emboli of vaseline. Please provide referrance. And if that were truly the case, without the ointment, that pt would have suffered a AE, for sure.
  6. 0
    Quote from IVRUS
    Muno,
    I am familiar with your distain for INS, however, It IS the standard across the nation to "seal" the site with ointment and then place an occlusive dressing over the site to prevent AE. I don't believe an occlusive dressing is sufficient by itself. I've also not heard of an emboli of vaseline. Please provide referrance. And if that were truly the case, without the ointment, that pt would have suffered a AE, for sure.
    I guess the hospitals/nursing homes I've either worked or been in have left the US ... NONE of them in the N. Illinois city I'm in use any sort of "seal". And neither I (have had several PICCs) nor the patients I've seen/worked with who had PICCs bought the farm due to lack of a 'seal' .... They (and I) got pressure held by a nurse, and a snug bandage.
  7. 0
    Quote from xtxrn
    I guess the hospitals/nursing homes I've either worked or been in have left the US ... NONE of them in the N. Illinois city I'm in use any sort of "seal". And neither I (have had several PICCs) nor the patients I've seen/worked with who had PICCs bought the farm due to lack of a 'seal' .... They (and I) got pressure held by a nurse, and a snug bandage.
    Well honestly, just because you haven't been privy to this practice, does NOT mean that those "in the know" and those with infusion savy, don't utilize this in their daily practice. I am glad in one way that you haven't been part of legal action where this protocal was not followed and the patient did END up buying the "FARM". It has happened.. Thankfully, not to U.
  8. 0
    Quote from IVRUS
    Well honestly, just because you haven't been privy to this practice, does NOT mean that those "in the know" and those with infusion savy, don't utilize this in their daily practice. I am glad in one way that you haven't been part of legal action where this protocal was not followed and the patient did END up buying the "FARM". It has happened.. Thankfully, not to U.
    And just because you use this in your area doesn't mean that all other nurses (and I've done plenty of IV/central lines/PICCs-- don't have to agree with you to have 'savy' ) are going to contribute to someone croaking because they didn't use a dab of goop Each facility has their own procedure manuals (and lawyers) and decides what data they use to make those procedures You follow different procedures- whoopee for you It's not the cornerstone of the continuation of mankind!! It must s**k to have so many idiots to have to explain things to

    You're kinda wishing I'd been sued, so I'd understand how deeply you feel about this, huh? I HAVE been sued (along with 3 other co-workers including the DON and admin) for something totally unrelated -- and it IS horrible, and I've gotten very bent out of shape over some of the issues related to that situation. It hurts to be involved in legal action, and colors views on the accusations they used.

    I had my Hickman taken out last week...a much bigger hole leading up through the tunnel to my jugular vein...no goop. 2x2s and Tegaderm.... and 6 days later, I'm still kicking
  9. 0
    Quote from IVRUS
    Muno,
    I am familiar with your distain for INS, however, It IS the standard across the nation to "seal" the site with ointment and then place an occlusive dressing over the site to prevent AE.
    Sealing the site with an ointment is not a "standard". A standard is something that has universal agreement, where examples of the standard not being followed are very hard to find and constitute true legal negligence. As you'll notice in this thread, use of an ointment is not universal, there are also professional practice sources that don't advocate the use of an ointment (for instance: Mosby's, http://www.medscape.com/viewarticle/508939_8, and others).

    Quote from IVRUS
    I don't believe an occlusive dressing is sufficient by itself. I've also not heard of an emboli of vaseline. Please provide referrance.
    http://www.ncbi.nlm.nih.gov/pubmed/2241775

    Quote from IVRUS
    And if that were truly the case, without the ointment, that pt would have suffered a AE, for sure.
    Our issue with the ointment is that decreases the ability of the occlusive dressing to do what it is intended to do; occlude. I agree that AE should be avoided as effectively as possible, which we believe consists of an occlusive that has not been compromised by a lubricant which will negate the seal, but you seem to overestimate the probability of an AE related to PICC removal, what is the incidence of AE following PICC removal?
  10. 0
    Good articles


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