PICC removal

  1. 0 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, alcohol swabs, etc.) and asked if he needed the measuring tape because i know the catheter needs to be measured and compare with the original length. the doctor said no he does need it and he won't measure it. doctor removed picc and put dressing, and charted and left. then my supervisor came and i told him the picc was just removed by the md. he asked me if i had measure it. i told him no that i asked the md if he needed the measuring tape and he said no. my supervisor said it was my responsibility to measure the catheter and chart it. i told him why when it was the md who removed the picc and not me. plus he was the primary doctor. if i had removed the picc myself, then of course i would measure the catheter. i was not even in the same room with the doctor when he was removing it.

    what do you guys think? this is the first time an md came to my shift (3-11) and removed a picc so i didn't know what to do.

    thanks,
    angel
    Last edit by agldragonRN on Jul 20, '11
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  3. Visit  agldragonRN profile page

    About agldragonRN

    agldragonRN has '5' year(s) of experience and specializes in 'Wound Care, LTC, Sub-Acute, Vents'. From 'The G. State'; 32 Years Old; Joined Sep '07; Posts: 1,623; Likes: 1,248.

    58 Comments so far...

  4. Visit  miss81 profile page
    12
    RN's remove all CVAD's here and we do not measure them. They have a colored tip and we chart that the tip is intact.
    michelle126, tokmom, CCL RN, and 9 others like this.
  5. Visit  IVRUS profile page
    2
    Quote from agldragonrn
    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, alcohol swabs, etc.) and asked if he needed the measuring tape because i know the catheter needs to be measured and compare with the original length. the doctor said no he does need it and he won't measure it. doctor removed picc and put dressing, and charted and left. then my supervisor came and i told him the picc was just removed by the md. he asked me if i had measure it. i told him no that i asked the md if he needed the measuring tape and he said no. my supervisor said it was my responsibility to measure the catheter and chart it. i told him why when it was the md who removed the picc and not me. plus he was the primary doctor. if i had removed the picc myself, then of course i would measure the catheter. i was not even in the same room with the doctor when he was removing it.

    what do you guys think? this is the first time an md came to my shift (3-11) and removed a picc so i didn't know what to do.

    thanks,
    angel
    the only time it does not need to be measured, is if it is a groshong iv catheter. the groshong catheter will have a black rounded tip. if that is present on removal, the catheter is intact. however, if it is not present, then there is a problem. measuring an open, non-valved iv catheter is important to ensure that the catheter measures the same as what was placed. if one does not have the measurements for what was placed and removal is ordered, the best you can do is assess after its removed to determine the absence of "jagged edges to the naked eye", but i'd still measure what i removed. or, if the catheter was removed with difficulty, then measurement is also imperative.
    you didn't mention that you provided gel, neosporin or betadine will work. the reason you want to use the gel is that it "plugs" the hole once the catheter is removed. this gel on a 4x4 goes directly on the hole which was left from the catheter's removal. then, a sterile transparent dressing (tsm) should be placed over the guaze once hemostasis resumes. alcohol, which you mentioned, may be used to aid in the tsm removal, but never should be used at the site as it can promote bleeding and it burns too.
    if you did not remove the iv catheter, the ownership of follow through on this task belongs to the individual who did the procedure. should you go sifting through the trash to retieve this catheter. no, i wouldn't. but i would chart that xyz doctor removed it, and then monitor the patient for s/s of catheter emboli, &/or air emoboli.
    tyvin and agldragonRN like this.
  6. Visit  agldragonRN profile page
    0
    Quote from ivrus
    the only time it does not need to be measured, is if it is a groshong iv catheter. the groshong catheter will have a black rounded tip. if that is present on removal, the catheter is intact. however, if it is not present, then there is a problem. measuring an open, non-valved iv catheter is important to ensure that the catheter measures the same as what was placed. if one does not have the measurements for what was placed and removal is ordered, the best you can do is assess after its removed to determine the absence of "jagged edges to the naked eye", but i'd still measure what i removed. or, if the catheter was removed with difficulty, then measurement is also imperative.
    you didn't mention that you provided gel, neosporin or betadine will work. the reason you want to use the gel is that it "plugs" the hole once the catheter is removed. this gel on a 4x4 goes directly on the hole which was left from the catheter's removal. then, a sterile transparent dressing (tsm) should be placed over the guaze once hemostasis resumes. alcohol, which you mentioned, may be used to aid in the tsm removal, but never should be used at the site as it can promote bleeding and it burns too.
    if you did not remove the iv catheter, the ownership of follow through on this task belongs to the individual who did the procedure. should you go sifting through the trash to retieve this catheter. no, i wouldn't. but i would chart that xyz doctor removed it, and then monitor the patient for s/s of catheter emboli, &/or air emoboli.
    the doctor removed the picc himself. actually, he asked me for the supplies. he said he needed suture removal kit (which he didn't use and gave back to me), 2x2 gauze,paper tape, and alcohol swabs. i then asked if he needed the measuring tape for the catheter and told me no. i did not know what kind of a catheter it was. but i was upset with my supervisor for lecturing me that it was my responsibility to measure the catheter and chart it. he made me feel bad like i'm incompetent or something and his tone of voice when telling me made me more upset because he sounded like he was blaming me. i told him "okay i didn't know." the doctor charted in his progress note that he removed the picc.

    thanks for the explanation!

    angel
  7. Visit  NurseLoveJoy88 profile page
    4
    Quote from agldragonrn
    the doctor removed the picc himself. actually, he asked me for the supplies. he said he needed suture removal kit (which he didn't use and gave back to me), 2x2 gauze,paper tape, and alcohol swabs. i then asked if he needed the measuring tape for the catheter and told me no. i did not know what kind of a catheter it was. but i was upset with my supervisor for lecturing me that it was my responsibility to measure the catheter and chart it. he made me feel bad like i'm incompetent or something and his tone of voice when telling me made me more upset because he sounded like he was blaming me. i told him "okay i didn't know." the doctor charted in his progress note that he removed the picc.

    thanks for the explanation!

    angel
    i think the doc should be responsible for measuring the catheter. however, since everything falls on the nurses i would have probably measured it anyway just to cya but still document that it was removed by md, no complications, etc, etc. my thought is that if the patient had a catheter embolism they would question the nurse since we are the last link in the chain in every situation. i wouldn't beat myself up over it. your boss seems like a prune. its a learning lesson for you , me, and others as well.
    agldragonRN, Katie5, eagle78, and 1 other like this.
  8. Visit  OldNurseEducator profile page
    2
    Quote from agldragonrn
    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, alcohol swabs, etc.) and asked if he needed the measuring tape because i know the catheter needs to be measured and compare with the original length. the doctor said no he does need it and he won't measure it. doctor removed picc and put dressing, and charted and left. then my supervisor came and i told him the picc was just removed by the md. he asked me if i had measure it. i told him no that i asked the md if he needed the measuring tape and he said no. my supervisor said it was my responsibility to measure the catheter and chart it. i told him why when it was the md who removed the picc and not me. plus he was the primary doctor. if i had removed the picc myself, then of course i would measure the catheter. i was not even in the same room with the doctor when he was removing it.

    what do you guys think? this is the first time an md came to my shift (3-11) and removed a picc so i didn't know what to do.

    thanks,
    angel
    does your institution have a policy on removal of the picc line. i would always follow this and you'll keep from getting in trouble. lesson learned...
    NRSKarenRN and agldragonRN like this.
  9. Visit  kainos profile page
    5
    So would your boss have preferred you to dig through the sharps container looking for the PICC after the MD deposited it there???
  10. Visit  BabyLady profile page
    2
    Quote from agldragonrn
    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, alcohol swabs, etc.) and asked if he needed the measuring tape because i know the catheter needs to be measured and compare with the original length. the doctor said no he does need it and he won't measure it. doctor removed picc and put dressing, and charted and left. then my supervisor came and i told him the picc was just removed by the md. he asked me if i had measure it. i told him no that i asked the md if he needed the measuring tape and he said no. my supervisor said it was my responsibility to measure the catheter and chart it. i told him why when it was the md who removed the picc and not me. plus he was the primary doctor. if i had removed the picc myself, then of course i would measure the catheter. i was not even in the same room with the doctor when he was removing it.

    what do you guys think? this is the first time an md came to my shift (3-11) and removed a picc so i didn't know what to do.

    thanks,
    angel
    what kind of picc's are you usings?

    we don't measure ours either because the measurements appear directly on the catheter and we simply check to make sure the tip is intact.

    there is no reason to measure if they appear on the catheter.
    agldragonRN and wooh like this.
  11. Visit  xtxrn profile page
    1
    I've had 3 (or 4?) PICCs removed, and they stuck a couple of 2x2's on it with a bandaid, and a little pressure for a couple of minutes, and called it a day- first one was in 2007, and I lived to tell about it I've removed countless subclavians, and a couple of PICCs, and measuring the PICCs was never part of it. We check the end, and document the usual site condition, catheter intact, and any problems.

    I go to the surgeon tomorrow re: getting rid of the Hickman-- they use conscious sedation for that (when they put it in, evidently I was 'unconsciously sedated' as the CRNA told me I snored

    It stinks that you have to go through so much hassle, and that an MD has to come to remove the PICCs at the LTC... never had to deal with that- or noted any co-workers NOT pulling it themselves when ordered.

    When PICCs first came about, RNs were certified to INSERT them- I was never interested in that- seemed like too much invasiveness for my pay grade
    agldragonRN likes this.
  12. Visit  IVRUS profile page
    1
    Quote from BabyLady
    What kind of PICC's are you usings?

    We don't measure ours either because the measurements appear directly on the catheter and we simply check to make sure the tip is intact.

    There is no reason to measure if they appear on the catheter.

    I would never just look at the markings on a PICC and say.... Oh, it's all there... Some PICC's start their cm markings at the distal end, whereas others start their cm markings at the proximal end. Did you place 43cm? And is the PICC measuring 43 cm now that it is out? Okay, I'm cool with that. but how do you make sure the "tip is intact" as you put it? If you chart that very thing, you're setting yourself up for a losing lawsuit.
    How did you determine that? Was a microscope brought to the bedside and you verified that the tip was intact?
    Was the catheter cut at an angle, and now it is straight across...ooopppps.
    And, unfortunatly, some of the markings, aren't easy to see, or decipher.
    A 3fr IV catheter, has markings so timy, that ya' better have good eyes, or good bifocals to see them, heaven forbid I'm looking at a 1.9 or 2 french line.
    For the Groshongs, thankfully they have a black tip which is how you know, it's all there!
    agldragonRN likes this.
  13. Visit  IVRUS profile page
    1
    Quote from xtxrn
    I've had 3 (or 4?) PICCs removed, and they stuck a couple of 2x2's on it with a bandaid, and a little pressure for a couple of minutes, and called it a day- first one was in 2007, and I lived to tell about it I've removed countless subclavians, and a couple of PICCs, and measuring the PICCs was never part of it. We check the end, and document the usual site condition, catheter intact, and any problems.

    I go to the surgeon tomorrow re: getting rid of the Hickman-- they use conscious sedation for that (when they put it in, evidently I was 'unconsciously sedated' as the CRNA told me I snored

    It stinks that you have to go through so much hassle, and that an MD has to come to remove the PICCs at the LTC... never had to deal with that- or noted any co-workers NOT pulling it themselves when ordered.

    When PICCs first came about, RNs were certified to INSERT them- I was never interested in that- seemed like too much invasiveness for my pay grade
    Well, you were truly "blessed" not to suffer an air embolism s/p removal if a 2x2 and bandaid is all they put on it!
    agldragonRN likes this.
  14. Visit  scg08rn profile page
    1
    I was taught that you measured the catheter and made sure the tip is intact.
    agldragonRN likes this.
  15. Visit  BabyLady profile page
    2
    Quote from IVRUS
    I would never just look at the markings on a PICC and say.... Oh, it's all there... Some PICC's start their cm markings at the distal end, whereas others start their cm markings at the proximal end. Did you place 43cm? And is the PICC measuring 43 cm now that it is out? Okay, I'm cool with that. but how do you make sure the "tip is intact" as you put it? If you chart that very thing, you're setting yourself up for a losing lawsuit.
    How did you determine that? Was a microscope brought to the bedside and you verified that the tip was intact?
    Was the catheter cut at an angle, and now it is straight across...ooopppps.
    And, unfortunatly, some of the markings, aren't easy to see, or decipher.
    A 3fr IV catheter, has markings so timy, that ya' better have good eyes, or good bifocals to see them, heaven forbid I'm looking at a 1.9 or 2 french line.
    For the Groshongs, thankfully they have a black tip which is how you know, it's all there!
    The next time you pull one out...look CLOSELY at the tip...you will see that it is slightly rounded...that is how you know the tip is intact. If it is not it will look similar to the tip of an IV catheter...cut off.

    No microscope needed.

    If you are not checking the tip and just measuring it...then you are not doing your job (and in my opinion, not charting clearly) either because if just the tip has broke off you won't pick up on that if you just simply measure it, as the tip is too small..you have to LOOK at it.

    We chart the length it was put in, we chart what the length was when we started the removal and look to make sure all the numbers are there and chart, "PICC line secured at 6 cm removed with tip intact." In fact, this is the policy of how to chart it.

    You are incorrect that charting "tip intact" sets you up for a lawsuit. The tip is THE END. That is pretty definitive.

    The PICC lines that we use in our unit, the markings are clear, so there is no question of where it is.

    So that is why the MD didn't feel the need to measure it...because the tip condition is visible to the naked eye.
    agldragonRN and wooh like this.


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