PERIPHERAL IV'S AND PICC SITES

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    IF A 20 GUAGE CATHETER IS INSERTED INTO THE SAME VEIN AS A PICC LINE, WHAT ARE THE CHANCES OF DAMAGE OCCURRING TO THE PICC LINE? WOULD AN XRAY HAVE CONFIRMED THE DAMAGE? IF A PERIPHERAL IV IS REMOVED THAT IS SUPPOSEDLY IN THE SAME VEIN AS A PICC LINE, WHAT ARE THE CHANCES THAT DAMAGE TO THE PICC COULD OCCUR? IF A SLUGGISH BLOOD RETURN AND RESISTANCE TO FLUSHING IS FELT WITH A PICC LINE,WOULD IT BE PRUDENT TO NOT USE THIS SITE FOR IV DILANTIN?
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    On our oncology ward, many of our pts. have piccs. If we need to have additional access, we usually use the other arm. If you can't, you may use a vein below the picc insertion site(if you can find one to use). If the picc is sluggish,try flushing with saline before trying to draw blood from it.What are you using to flush your lines with? At our facility, we use a heparin/saline mixture as just saline alone does not seem to prevent the picc lumens from becoming plugged by clots. I find that piccs become plugged far more frequently than central lines, and this may be due to the smaller lumen size. On our unit, we usually use double lumen piccs and use the larger lumen(red) for infusing blood products and drawing bloodwork. The singe lumen piccs are used rarely and nursing staff do not like them much.(plug too easily). Hope this helps.
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    Generally, you should not put another IV in the same vein as a picc line. If absolutely no other site is available, then a short peripheral IV can be inserted below the picc line - preferably in a different vein but if it is in the same vein you'd want to remove it as soon as possible since this may affect the flow of blood and medication running thru the picc site OR you may also be dealing with an incompatibility problem. Many of the lines become sluggish due to the small internal diameter (ID) of the lines. Johnson and Johnson's Biovue (spelling?) is a polyurethane PICC line and the internal diameter is much larger. The polyurethane catheter is stronger and allows for the actual outer wall to be thinner - therefore the actual inside "hole" is much bigger. So , flow problems may be related to which product brand of PICC you are using. I also teach the staff that flushing techniques can cause sluggish catheters - make sure that the staff maintain positive pressure when flushing the last 1/2 cc and if they use the pulse method to flush it seems to help (flush as little and stop a second then flush and stop, flush and stop, etc). Another problem with catheters is that over time they just collect celluar and chemical debris inside the catheter and gradually the aspiration of blood and flow of fluid becomes increasingly more difficult. We use to instill urokinase and let it dwell inside the catheter 15 minutes and aspirate it out to clean out the catheter prophylactiacally as needed. But urokinase is no longer (maybe permanently) available. So you could use an aliqiuot of TPA (what is used for MI's) - very expensive - one vial of TPA is drawn off into 10 syringes of equal part TPA and then frozen (contact the company for the exact process). Then thaw one syringe and instill it into the catheter when needed. This reduces TPA waste and helps with the catheters. I hear this a lot as I travel around the country teaching PICC and midline therapy programs. Sometimes it is a function of the catheter and sometimes it is what the staff is doing (or not doing) and how. Hope this helps.

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    jo mitchell, RN, BSN, OCN, President
    Coyote Enterprises


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