PICC removal - page 5

by agldragonRN

15,137 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. 0
    Quote from MunoRN
    Evidence based Practice Recommendations supported by no evidence would have a level of evidential support fairly described as "poor".

    That case of the smoker wasn't a PICC.

    Why is it you don't believe a TSM seals 360 degrees around the site?

    I'm still not clear if you're suggesting that Nurses should go against their facility's policies?
    I am advocating that a nurse, knowing what is appropriate and in the best interest of their pt, advocate for best practice to produce optimal patient outcomes. I've gone to my education liason in a hospital setting and showed them standards, and got P&P changed. We all need to be pt. advocates.

    And, I never said the smoker incident was from a PICC... I said CVC only.

    Are you a Certified RN in infusion therapy?
  2. 1
    What are you measuring for when you pull a PICC and what are you comparing it to. When patients come to the TCU I work we very very rarely have records of PICC insertion so we really don't know how much was inserted into the body to compare it too. I chart "PICC d/ced at 2100, tip appears intact."

    IVRUS can you post some links and resources to your information. I have never heard of applying vaseline to a PICC site. Is this a new standard as it seems a lot of nurses here haven't heard of it before? Thanks in advance for your knowledge.
    xtxrn likes this.
  3. 0
    Should I test the Hickman site??? Maybe go submerge in the tub and see if I cause bubbles ?????
  4. 0
    Quote from babylady
    you don't have to over-analyze it and you are not responsible for supervising the physician in any way.

    this is what i would chart: picc removed by dr. jones.

    then chart how the site was dressed. i might write a couple of words if the site appeared to be red, the amount of bleeding, etc, but since you did not remove the picc, you are not responsible for how it was removed any more than you would be responsible if you were an or nurse of how a surgery was performed.

    dr. jones is responsible for charting his own procedures, not you.
    thank you so much! i did not want to argue with my supervisor as he pulled the "for patient's safety" card but it is not in my job description to supervise the physician. yes i am an advocate for my patient but in this case i will not tell the doc to measure the catheter especially he told me already he would not be measuring it. yup i charted similar to what you wrote.
  5. 0
    Quote from casi
    what are you measuring for when you pull a picc and what are you comparing it to. when patients come to the tcu i work we very very rarely have records of picc insertion so we really don't know how much was inserted into the body to compare it too. i chart "picc d/ced at 2100, tip appears intact."

    ivrus can you post some links and resources to your information. i have never heard of applying vaseline to a picc site. is this a new standard as it seems a lot of nurses here haven't heard of it before? thanks in advance for your knowledge.

    you are measuring the length of the catheter when the picc is pulled and compared it to the original length. we have a record of the xray of the picc with measurements in centimeters. this record is from the hospital and i always look for this when i do new admission/readmissions (assuming the patient has a picc). i have a couple times called the hospital after the patient arrived and this info is missing and asked hospital to fax it to me.

    we are not supposed to use the picc without this information. however, if the hospital cannot fax it to me for some reasons, i will get a t.o. from the md to use the picc without this information.
  6. 0
    Quote from IVRUS
    I am advocating that a nurse, knowing what is appropriate and in the best interest of their pt, advocate for best practice to produce optimal patient outcomes. I've gone to my education liason in a hospital setting and showed them standards, and got P&P changed. We all need to be pt. advocates.

    And, I never said the smoker incident was from a PICC... I said CVC only.

    Are you a Certified RN in infusion therapy?
    What your evidence that this produces better outcomes?

    You seemed to say it was a PICC when you said "he also "sucked" in an air embolus which extended from the insertion site of the now removed PICC"

    I am not certified in Infusion therapy, I just prefer solid rationale and evidence to "because I told you so" reasoning.

    I looked up the official synopsis last night at work for our policy. Their first issue was that they couldn't get it to work, even to a small degree. They used a coffee stirrer in a piece of foam to simulate a PICC tract as it exited the skin, hooked it up to -10 to -15 cm H2O of suction (same as negative intra-thoracic pressure with inspiration) and applied petroleum jelly to the opening. Even after repeated applications the petroleum wouldn't maintain a seal for any amount of time, the jelly was always pulled apart at the opening by the negative pressure.

    The clincher though was from Risk Management who vetoed the idea based on something called the "Mulder Rule" The Mulder rule states that doing something that FDA required labeling says specifically not to do is considered automatic malpractice. All petroleum jelly is required by the FDA to carry the same warning; "Do not use on deep wounds / Puncture wounds". A PICC insertion wound could certainly be argued to be a "puncture" type wound. There was even a question on the part of Risk Management of whether or not this would be considered a felony, although it sounded like it most likely would not, just negligence, which is still pretty bad.
  7. 1
    On page S58 in the 2011 Infusion Nurses Society Standards of Practice, practice criteria for Nontunneled CVAD's read as follows:

    F. Caution should be used in the removal of a non-tunneled CVAD, including precautions to prevent air embolism. Digital pressure should be applied until hemostasis is achieved by using manual compression and/or other adjunct approaches such as hemostatic pads, patches, or powders that are designed to potentiate clot formation. The nurse should apply petroleum-based ointment and a sterile dressing to the access site to seal the skin-to tract and decrease the risk of air embolus. When removing the CVAD, the nurse should position the pt so that the CVAD insertion site is at or below the level of the heart to reduce the risk of air embolus.

    In addition,
    Here is an interesting article..

    http://www.thefreelibrary.com/Near-f...y.-a0110813712
    casi likes this.
  8. 0
    [color="mediumturquoise"]dead horse begging to rip :d

    ivrus-- people don't agree with your insistence- you don't agree with those who don't agree with you :d

    is this going to go on forever :d

    is there any chance to agree to disagree ?? :d
  9. 0
    Quote from xtxrn
    dead horse begging to rip :d

    ivrus-- people don't agree with your insistence- you don't agree with those who don't agree with you :d

    is this going to go on forever :d

    is there any chance to agree to disagree ?? :d
    hello.... someone asked me to site where i got my info, dead horse or not, some people want to do things following standards. i merely sited them.
    agreed... amen.
  10. 0
    Quote from IVRUS
    Hello.... Someone asked me to site where I got my info, Dead horse or not, some people want to do things following standards. I merely sited them.
    Agreed... Amen.
    Great Let's go get a fruit smoothie and hang out at the beach


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