5 french vs 6 french PICC

Specialties Infusion

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Specializes in Vascular Access Nurse.

Hello to all,

We gave switched from a 6 french triple lumen power picc to a 5 french triple lumen power picc. The 5 french has one 18 gauge port and two 20 gauges. Obviously the 20 gauge ports are more difficult to flush. Has anyone else out there switched to the 5 french triple lumen picc? We're contemplating switching back to the 6 french and wonder what others are doing. Thank you!!! :nurse:

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Specializes in Vascular Access.
Hello to all,

We gave switched from a 6 french triple lumen power picc to a 5 french triple lumen power picc. The 5 french has one 18 gauge port and two 20 gauges. Obviously the 20 gauge ports are more difficult to flush. Has anyone else out there switched to the 5 french triple lumen picc? We're contemplating switching back to the 6 french and wonder what others are doing. Thank you!!! :nurse:

Wow,

What populi do you serve that can accomadate such large french size catheters????

Also, remember that when you have a 5 or 6 french IV catheter, you can easily occupy > 50% of that blood vessel. I pray that no more than 30-40% of the vessel is taken up by the IV catheter. When you are > 50%

your phlebitis and thrombus rates soar and blood flow around the catheter is greatly diminished. Plus, there is a correlation to increased infections when dual lumens are present, not to mention a triple lumen!!

I pray that you seriously reconsider going to a larger catheter. If the 5 french is adequately/appropriately cared for, you shouldn't see diminished flushing abilities.

:twocents:

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Specializes in Vascular Access Nurse.

We are an acute care facility that cares for all ages. Of course, we don't put 5 or 6 french PICCs in pediatric patients.....they would receive a 3 or a 4. Usually the only time an adult patient receives a 4 french single lumen PICC is for home therapy. Most of our ICU patients require 3 lumens and sometimes even that is not enough....we have had patients with a triple lumen PICC in each arm at times. Most of the patients on a regular nursing unit need at least a double lumen PICC. We used 6 french triple lumen power PICCs up until about 5 months ago and didn't have any problem with them. We use BARD Power PICCs for almost all of our picc insertions. The "diminished flushing ability" with the new piccs is due to the smaller lumen size of the grey and white ports. They are difficult to flush, even when first inserted. We would like to know if others are having the same results. IVRUS, I'm surprised that you're surprised about the 5 or 6 french catheter size...we've been using these piccs for a while with no difficulty. I'm also surprised that single lumen piccs are adequate access for you, but I don't know what population you serve either. Of course multiple lumens can increase the potential for infection...we have had one of the lower CLAB rates in the country. We do central line rounds at least twice a day and monitor any central line closely.

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Specializes in cardiac- tele-ICE-SHU-cath lab/ir.

Hi

I use 5 fr double lumen and triple lumen piccs and have beeen just recently going up to 6 fr triple lumens in the icu, er, and or. I use the bard power piccs as well. I do find that the gray and white ports are sluggish very quickly. I spend a lot of my time working on the maintenance aspect. The 6 fr seem to be working out a bit better. My concern is that a fair amount of my patients cant handle a 6 fr. i havent had a problem with phelbitis or thrombosis. My program at the hospital is fairly new, just over the past year. I am putting in about 50 a month, we are a small hospital of about 110 beds. There has been a real increase of the use of piccs in my hospital and a lot of education going on.

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Specializes in Vascular Access Nurse.

PICCME,

Thank you for your input....I greatly appreciate it!

Deb

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Specializes in cardiac- tele-ICE-SHU-cath lab/ir.

I'm glad I could add to the discussion. I think its great to have a place to come and discuss the PICC biz! There arent that many of us out there yet, yet being the keyword!

Mary

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Specializes in Infusion Nursing, Home Health Infusion.

Actually we put in more 6 Fr PICCs in than we do 5 Fr now.....we have not had any siggnificant change in our complication rates....We place most of these in our ICUs as our docs only keep our TL percutaneous lines in for 4 days or so....we often have pts with multiple PICCs as well. We do check our vein size and make sure it is at least2.0 mm in size. We also carefully evaluate what it will be used for. If the line will be used for CVP monitoring,,there is one lumen already accounted for..another for a med line and there you go you only have one left...so that is why we usually go ahead and put the 6 fr in ,esp when they are unstable. If we know they are getting better and just need a DL then we put that in. We use the SL if pt is going to our SNF or another or home or will need long term abx..even if they are going home with PICC they often need a DL if they are on more than one abx or medication as you often do not know the delivery mode. It is a case by case basis..so you really need both available and then base it on vein size..therapy needed...pts risk factors for thrombosis or other complications

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Specializes in cardiac- tele-ICE-SHU-cath lab/ir.

I always go with the triple lumen in either the ICU, OR, or ER. I really dont put in any single lumen PICCs, even on outpatients as they are usually either on more than one abt, or lack of trust in the flushing. I find they dont come back as often with a clogged port. I am using more and more 6 fr piccs. I am also changing over our hospital to positive pressure caps.... and hoping it will help out my problem with sluggish ports! I just keep hoping.,..... lol

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Specializes in Infusion Nursing, Home Health Infusion.

Picc me... Also look into flushing technology...read lynn hadaways article..technology of catheter

flushing...i am surprised at times that nurses do not follow our protocols and continue to not scrub caps properly...flush per our protocol and especially after a blood draw..most of our occlusion can be traces to an improper flush or no flush after a blood draw...there is also a great article on cap technology and structure and kinds in last mos ins journal..they are suggesting using the term positive dispacement cap/valve..check it out it may help with your process

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Specializes in Intravenous and PICC Specialist.

Regarding vein size to catheter sizes, now that we are all using ultrasound it is easy to measure the diameter of the vein prior to insertion. Measuring the smallest area without the tourniquet with the vein in the natural state the vein size should be at least 3 times the catheter size. Rule of thumb is 6Fr needs to be 6mm, 5Fr then at least 5mm, 4Fr then 4mm. The catheter should not take up more than 33% of the vein. We talk about this in the Advanced Ultrasound Assessment course and will be discussing it at INS in two weeks at the Sonosite booth.

Hope this is helpful...

Warm regards,

Nancy Moureau

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Specializes in cardiac- tele-ICE-SHU-cath lab/ir.

Thanks for the helpful hints, its most appreciated!

Mary

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Specializes in ER, IR, Cath Lab.

We rarely place 6fr triples because we had DVT isssues, especially when placed all the way to the hub for bleeding control. We now usually place a dual power, don't hub the picc and use BioSeal around the insertion site to control any oozing or bleeding. We rarely get dvt's and have eliminated lots of dressing changes. We were thinking of bringing the 6fr back but I recently read a Bard study that shows that DVTs with 6fr piccs are a common occurrence.

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