Quote from suhurd
I.ve been doing Piccs both in home health and ICU for 15 years. Today I had a newly certified Picc Rn tell me that the standard is now to use the 45cm instead of the 55cm and always insert it to the hub. I've always carefully measured the length of the insertion based on the patients size. To insert to the hub is totally against what I've been taught. What if the line breaks? How far out do the rest of you leave the cath from the insertion site? It used to be that a line wasn't considered a true picc unless it was in the superior vena cava? The newly certifieds are telling me anyplace such as the suclavian is a picc and not a midline cath. Can anyone help clear up these questions for me? Thanks.
You cannot simply insert a 45cm PICC in any patient to the hub. At the facility in which I am employed, we have been using Ultra Sound for venous identification, and since our insertions are now much higher above the antecubital, (Brachial/Cephalic/High Medial) the 45cm catheter is most desirable. You still must measure the patient from the insertion site to the SVC. The closer the hub is to the insertion site, the less chance there is to the catheter being tugged upon. When Radiology inserts PICCS, they are always to the hub. It also depends upon the type of PICC you are using. If you use an open ended PICC, they can be trimmed to the "ideal" length, but if you are using a double lumen Groshong, they cannot be trimmed and measurement must be more accurate if you wish it to be inserted up to the hub. With a single lumen Groshong, it can be trimmed to the desired length. We also now use stat-locks to secure our catheters, and change them once a week along with our dressing changes. If the catheter is not inserted to the hub, we place a flexible wing adapter to the insertion site, then attach it to the stat-lock. The new Groshongs (which we use) now have much more durable extension lumens and since these have been released from the company (Bard), I cannot remember the last time I have repaired one.
Who are the new certifieds? They are "wrong" if they are telling you that a PICC is a PICC if it is in the subclavian. It is only considered a PICC if it is in the SVC/Cavio Atrial Junction, or the Right Atrium. If a PICC is in the sub-clavian, it is considered to be "Mid-clavicular". If it is anywhere from 6 ins to axilary, it is then considered to be a mid-line. FYI, it is also recommended that TPN, and Vancomycin only be infused through a "true PICC", SVC or R. Atrium, because of the nature of sub-clavian stenosis. The pH of Vancomycin is so caustic that it causes severe irritation of the peripheral, and subclavian vessel and should only be infused in a true PICC placed catheter, and we all know the rules of TPN. I hope this information has helped.