triple lumen PICC lines - page 2

by PICC chic

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has any out there in the PICC world placed any 3L PICC's? I am hoping to trial some in the next couple of weeks. I am very excited, there are many patients that I PICC that could definately use a triple lumen. Just wondering... Read More


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    Quote from PICC chic
    has any out there in the PICC world placed any 3L PICC's?
    I am hoping to trial some in the next couple of weeks. I am very excited, there are many patients that I PICC that could definately use a triple lumen. Just wondering if anyone has any feedback on them.

    We have used some triple lumens - one word of caution though, they are open ended catheters. The ports come with clamps and they must be clamped when not in use to avoid occlusion. They should also not be sent home with a patient because they are at too great a risk if they break or the cap comes off.
    We use them in patients with lots of stuff going on, but we always remove or exchange before transferring out of the hospital.
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    PICC ACE, where are you placing 2 5fr PICCs? And I mean where in the arm....not where in the world!!! Are you tying up both arms with PICCs or using basilic and cephalic on the same arm? I'm thinking that's a lot of PICC running thru the same subclavian vein. What is the rate of thrombous and fibrin sheaths doing this?
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    Gail-Anne:
    I've done them both ways--one in each arm and two in the same arm. If I think I need to use the same arm I check with the ordering MD to see if they have any concerns about two lines going into one subclavian. I've only had to do that three times in the last 2 years,so it doesn't happen often. In two cases,they were postop CABG's that had a prolonged ICU stay and they really needed their IJ's out. In that case I'd think the complication rate for 2 PICCs in one subclavian would still be less than one IJ. Also,since one of these patients had both radials harvested for the bypasses,I needed to leave one arm free for BP's. The other fellow has a big abdominal surgery and his two PICCs in the same arm worked fine for over a month.
    I 'googled' it briefly but couldn't find any data on the complication rate for 2 PICCs in one arm. My gut feeling is that the rate may be a little higher but then since one of them is brachial or cephalic,this fact alone may bump up the rate itself.
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    We keep the Bard 6Fr on hand in our facility and I have placed them several times - always on ICU patients who were on numerous drips/TPN/etc.. that really required three lumens. I have never had a problem with phlebitis or thrombus with the triple lumens - I attribute that to careful assessment of the patients I use them on. So far, the other Picc nurses at my facility have not placed any of the triple lumens - I think they find them a little scary because they are a larger line.

    I have never placed two piccs in one arm - that idea is new to me. If I found I needed more lumens I might place a second line in the other arm, or just place a triple lumen. Those of you who are placing two lines in one arm, how can you be sure that both lines don't end up in the same vessel in that arm? I mean, it is possible the way veins sometimes branch into other veins. If that happened I would think that would really increase that risk of phlebitis or thrombus formation.
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    I place triple lumen PICCs, and use only the Bard Power Picc. Great advantage to have three lumens, one of which can be used for contrast. Particularly good for ICU patients.
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    We use triple lumen piccs in our small community hospital in the CCU. We love them. The staff nurses love them. We dont have any problems with clogging,clotting,emboli or anything. Believe it or not. They are not hard to place, even with very sick pt's. We have been thanked many times over because they dont have to be sent to IR. We use 6FR TL Bard POWER PICC's.
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    Triple lumen PICCs are awesome! If I walked out of the ICU placing a single or double rather than a triple I would definitely get attacked by the nurses. They would be furious!:angryfire As you can imagine, the three lumens are great in patient who have a ton of meds running. I remember the first time I placed a Bard 6Fr TL PICC...the introducer scared me (it was so big). Now I have placed hundreds of them! Go get 'em!


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