Use of peripheral inserted central catheters ( PICC )

  1. Hi

    In our practice, peripheral inserted central catheter placement is ICU nurse job. We call PICC "our CVC". What`s your expirience ?
    Do you use PICC in your practice? PICC placement - doctors or nurse?
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  2. 19 Comments

  3. by   Tweety
    We have a few nurses trained to insert PICC's. Lately it's been done by the radiology service, they intert under flouroscopy.

    There was a push about five years ago to get PICC certified nurses, but due to lack of committment it went nowhere. This institution isn't big on education.
  4. by   julieK
    I work on an oncology unit and we have a lot of PICC's. Mostly they are placed at the bedside by the PICC nurses. If the PICC nurses cannot get it or the random doctor decides for some reason they should go to Interventional Radiology, then they go downstairs for it. When they are placed by the PICC team, though, they follow it for the life of the PICC (change dressings, etc.) and remove it when it is no longer needed. When they are placed by IR, the floor nurses are responsible for dressing changes.

    -Julie in NYC
  5. by   heart queen
    Our unit is long term, heart transplant, we use ALOT of PICC's. we have IV team who are credentialed in inserting them, just call a consult. They use ultrasound to determine vein flow and assess for clots before selecting an arm. If they have trouble the patient is sent to radiology to have it inserted.

    The IV team or radiology documents arm circumference at insertion site, a cxr is then done to ensure placement. Our picc's are then flushed, each line q8 hr. with 10 NS. With blood draws, we discard 10cc's, or 15 if cotting factors are drawn, then flush with the 10cc's NS after. The PICC team does the dressing change Q7 days or ya call them if messy.

    The circumference is posted at HOB, that arm becmes a restrict for draws and BP's like a dialysis shunt. With swelling we re-measure and take a CXR if warrented. Have very few infections or lines clotting off.
  6. by   TREBORICUNURSE
    Must say I am impressed with yours IV and PICC teams. In our ICU, everything about PICC is ICU nurse job - insertion and dress changes. To confirm good PICC placement we just connect IV line to catheter. Then we check for blood reflux - move infusion bag under heart line for a short time. If blood reflux in IV line is visible, that`s it.

    Also, must say that during the war in our region, many lives is saved by PICC. We just don`t have central catheters for subclavian or iugular placement. For almost a year, PICC was the only central cathters in our practice. All ICU nurses become PICC experts during that period.
    Doctors and peripheral vein? Hm, hm... not a good idea in my ICU.

    One more question : Do you use PICC for CVP mesurement?
    We use PICC for CVP. But, before mesurement, chest x-ray must be done to confirm PICC placement in v. cava.

    And last question: I see that some of you use ultrasound for PICC vein detection. What kind of ultrasound and ultrasound probe do you use? Can you describe that procedure?
  7. by   renerian
    Always used a PICC certified nurse.

    renerian
  8. by   heart queen
    Now I'n not 100% sure what type of ultrasound, but is is a cmall portable one that PICU nurses use to find veins.
  9. by   normankm
    Heart Queen would you happen know how the IV team decides what fr size to insert. I work in a Oncology unit and it seems to me that 40% of the placements clot or need repair, I think they need to put in larger sizes in most cases but I don't have any knowledge or background with PICC's. Any help would be appreciated.


    Quote from heart queen
    Our unit is long term, heart transplant, we use ALOT of PICC's. we have IV team who are credentialed in inserting them, just call a consult. They use ultrasound to determine vein flow and assess for clots before selecting an arm. If they have trouble the patient is sent to radiology to have it inserted.

    The IV team or radiology documents arm circumference at insertion site, a cxr is then done to ensure placement. Our picc's are then flushed, each line q8 hr. with 10 NS. With blood draws, we discard 10cc's, or 15 if cotting factors are drawn, then flush with the 10cc's NS after. The PICC team does the dressing change Q7 days or ya call them if messy.

    The circumference is posted at HOB, that arm becmes a restrict for draws and BP's like a dialysis shunt. With swelling we re-measure and take a CXR if warrented. Have very few infections or lines clotting off.
  10. by   nursing04
    Hello. At the hospital I work for they do not do blood draws through the pts central line whether it be a Picc, portacath, whatever. This is to reduce the risk of infection. To me I would think a pt is more at risk for an infection by being stuck 2-3x a day for blood draws. What is your hospital policy on this? Thanks
  11. by   tbpmom
    I have a question regarding PICC use?
    What is best practice regarding checking glucose levels q 2 hrs ( or more often) because the patient is on an insulin gtt?
    A nurse was telling me she thought another nurse was lazy because she would do fingersticks on her patient rather than draw off a PICC and waste blood every 2 hrs for accuchecks.
    I told the nurse I also do fingersticks as I think it is too risky regarding infections and also loss of blood as many of our patients are fresh post-open hearts, and are already with hgb.s in 8-9 ranges, and are at great risk for iatrogenic infections and that fingerstick would seem less invasive than q 2 hr 10+ ml blood draws off a highly risky, potential infectious source.

    Thanks
    Last edit by tbpmom on Jan 10, '09 : Reason: msitakes
  12. by   NiteyNite
    Quote from tbpmom
    I have a question regarding PICC use?
    What is best practice regarding checking glucose levels q 2 hrs ( or more often) because the patient is on an insulin gtt?
    A nurse was telling me she thought another nurse was lazy because she would do fingersticks on her patient rather than draw off a PICC and waste blood every 2 hrs for accuchecks.
    I told the nurse I also do fingersticks as I think it is too risky regarding infections and also loss of blood as many of our patients are fresh post-open hearts, and are already with hgb.s in 8-9 ranges, and are at great risk for iatrogenic infections and that fingerstick would seem less invasive than q 2 hr 10+ ml blood draws off a highly risky, potential infectious source.

    Thanks
    I wouldn't waste 10mL of blood every two hours..... Hook up a Vamp, it takes two minutes.
  13. by   tbpmom
    Quote from NiteyNite
    I wouldn't waste 10mL of blood every two hours..... Hook up a Vamp, it takes two minutes.
    But these are patients on the step-down where vamps are not used.
    Plus I have never seen vamps used on PICC's.
    These are power point PICC's and are Vamps OK to use with them?

    Thanks.
    :typing
  14. by   RochesterRN-BSN
    I'm curious are you nurses that work in ICU's and having to place PICCs certified? I thought that was a state requirement. I worked in a hospital with PICCs and only the team could place as they were certified and they all used the bedside ultrasound as well and sent a pt to radiology when they couldn't get it. They changed some of the dressings but we had to do them too. It was a treat if they did your patients....one less thing to do! lol We NEVER EVER would use a line without CXR for placement.......you could be written up and even fired if you used a line before placement checked. As far as blood draws. I have mixed feelings......I think some of the results aren't always accurate even with a good waste. And honestly I can draw the old fashioned way much quicker! But then again this is uncomfortable for the patient and one of the reasons they may have the line is they are a TOUGH draw and needs labs often. So.......

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