Was picc line damage or ???????

[ivbear]

Hi I wanted to know if any one out there has a policy in their hospital about the number of IV's that a patient could have place on one extremity.... I'm the coordinator for our hospitals PICC team which is very new. I have a concern about the number of lines that can be placed on a patients extremity. We recently had a patient with a new 5fr picc line place in the basilic vein above the AC with confirmation of SVC tip placement. The patient had a 22 gage forearm PIV and due to an MRI study a 18G PIV was placed on the AC, after the line was placed by bedside nurse. The patients left arm was compromised and could not be used. The patient was also getting NIBP performed on the right extremity for non reliable lower extremity BP's. Less than 24hr the insertion site for the picc line began to leak and the line was removed, 22 gage and 18g remained in place. Catheter was not saved to evaluate if the PICC line was damage. Does any one have a policy to prevent multiple line placement on same extremity in a stable patient. Any information, comments or suggestions are welcome.

Thanks.

[SoldierNurse22, BSN, RN]

We didn't have a policy--just common sense. If you have a functional PICC line, most of the time, you don't need any additional lines.

The exceptions we saw were when we had patients who needed chemo, TPN and a PCA at the same time. Then we'd occasionally get up to 3 IV sites on the same patient.

[Asystole RN]

We almost exclusively place power injectable PICCs for inpatients. The extremity that has a PICC placed should not be used for any blood pressure monitoring nor venipunctures of any kind for any reason due to a high risk of upper-extremity venous thrombosis, (UEVTE). If a patient needs multiple access points we will replace the PICC with the appropriate lumen size with an over-the-wire exchange if the site looks good. If the patient needs more that 3 lumens it is not unheard of to place a midline in the contralateral extremity along with the multi-lumen PICC.

If a PICC is leaking it needs to be investigated to rule out UEVTE and/or catheter malfunction. PICCs should not be breaking nor leaking, most PICCs should be able to last months to years, and if found needs to be reported to the manufacturer and FDA.

Most of the "leaking" catheters I have investigated were either the result of the needless access device not being secured tight enough on the catheter and midlines developing UEVTEs and back-flowing with flushes/infusions.