PICC lines-infusion pump required?

[veinnurse]

I am working for a home care company that services PICC patients. They presently use the "Dial-a-Flow system to regulate the PICC lines. Every place I have ever worked before, required PICC lines to be placed on an infusion pump.

I would appreciate hearing what your policies and procedures are.

[iluvivt, BSN, RN]

Home care can be different than hospitals. Most hospitals will use a pump on all CVCs to prevent errors and free-flow but you will not find any place that says you must use a pump for medication administration in the home care setting. The most important thing you need to ask is what is best for this patient and then advocate for it, If your patient has any continuous infusions it would be unwise not to use one. I would be asking for one immediately. Now lets look at another scenario. Lets say you have a daily dose of Vancomycin in 250 ml via a 4 French PICC line. You could safely administer this through a dial-a flow type of device. This should include your evaluation and assessment that after you have done your instruction,they are competent. I suspect your agency may be doing this for many reasons....possibly to save $.....possibly to make it easier for the patient (less for pt and/or caregiver to learn). What is their rational

[bobnurse]

I personally feel that all infusions should be administered via pump through picc lines. Just think about it. Your administering blood through a picc and the flow is decreased...Patient coughs, tubing kinked or some other external/internal force. There is no alarm to tell you this. So you come to check on the patient and find that the picc is now clotted up. Same thing with drugs, dextrose, lipids, or precipitates will build up in the line and cause occlusions.

Just my 2 cents, but i think it will extend the dwell times of your piccs by using pumps.

[iluvivt, BSN, RN]

Now, I did not say that in a hospital or in a skilled nursing facility not to use an infusion pump. In these setting this is a wise choice,especially in the safety conscious health care enviroment. The question was in relationship to IV home care and there many different kinds of delivery systems available and many are specific to a a non- traditional infusion setting. One example is an elastomeric delivery system that you physically can not use a pump,but you can safely hook this up to any venous access device. Many patients are self pay or do want to not rent a pump. Remember...... in the home setting one of the things to consider is the pts lifestyle and needs.

Many patients are working and must administer their antibiotics at their workplace. Many physcains will select a long acting antibiotic so pt will only have to do a qd or bid administation (of course not only possible). It is perfectly acceptable to administer an antibiotic using a dial a flow type device in the home care setting.

As you can see home infusion is a whole different ball of wax and each situation is carefully assessed so we can send out a workable situation for the prescribed therapy.

[iluvivt, BSN, RN]

Now, I did not say that in a hospital or in a skilled nursing facility not to use an infusion pump. In these setting this is a wise choice,especially in the safety conscious health care enviroment. The question was in relationship to IV home care and there many different kinds of delivery systems available and many are specific to a a non- traditional infusion setting. One example is an elastomeric delivery system that you physically can not use a pump,but you can safely hook this up to any venous access device. Many patients are self pay or do want to not rent a pump. Remember...... in the home setting one of the things to consider is the pts lifestyle and needs.

Many patients are working and must administer their antibiotics at their workplace. Many physcains will select a long acting antibiotic so pt will only have to do a qd or bid administation (of course not always possible). It is perfectly acceptable to administer an antibiotic using a dial a flow type device in the home care setting.

As you can see home infusion is a whole different ball of wax and each situation is carefully assessed so we can send out a workable situation for the prescribed therapy. :typing