Charting Picc lines
- 0Feb 15, '13 by Nursingstudent0636I'm learning my charting and I'm confused on exactly how to word something. Can I say...
Right Picc line infusing D5W at 25cc/hr. No edema or redness noted
or is there a better way to chart picc lines?
- 0Feb 15, '13 by akulahawkRN, ASN, RN, EMT-PThe only thing that I'd add is that there may not be a "proximal" or "distal" port... but those ports may be distinguished by color. If that's the case, just document which color port is being used. Otherwise, pretty much the above documentation is really all that is needed.
- 1Feb 16, '13 by iluvivtSince a PICC is a central line you want to assess and comment on more that just the how the site looks. If you are doing a short note you can say something like right arm dual lumen PICC with D5W infusing at 25 ml per hour. There are no s/sx of any PICC related complications observed. The dressing is CDI. You do not need to name the vein it is in as this has already been documented when it was placed and you cannot tell by looking if it is in the Basilic or Brachial...best not to guess.
So now what is the assessment:
dsg is CDI and is not outdated nor are the caps and they should be clean too without any blood or debris on them
You need to assess for s/sx of thrombosis (both central and upper arm)
You need to assess for s/sx of local or systemic infection
you need to make sure all lumens have a blood return and flush with ease
you need to make sure the entire PICC is under a TSM dressing (OK for the tails to be free) if any of the PICC is exposed bacteria can track into the insertion site
you need to know where the tip of the catheter is to make sure it is central. This has been verified when it was inserted and you will have a measurement that is externally visible. This varies so lets just say in this case it is 5 cm. So make sure you have 5 cm visible. You can see through the TSM dressing. If the measurement has changed you need to call an IV nurse as remedial action may be needed. The SVC on average is 7 cm long so if you have catheter outward migration of just a few cms in can make a difference and needs to be checked.
- 1Feb 16, '13 by hodgieRNMention whether or not it is valved. Some PICCs have valves, while others have clamps. Non-valved PICCs can be used for central venous pressure (CVP) readings while valved PICCs can not.
Mention if it is a Power PICC or CT PICC. CT scan uses contrast during diagnostics tests and that needs to infuse at a (lets say fast) rate. There are PICCs that are not compatible for CT. If they aren't, the PICC can rupture or the end of it will squirt around like a fire hose and displaced.
We always mention if it is a power PICC or if it is valved or non-valved.
Also mention where it terminates. It really matters if the end of it is in the atrium, the cavoatrial junction, the SVC, or if it looped somewhere. It shows that you verified the placement. If you are auscultating the air in an NG while also checking the placement of the NG with the latest xray, shouldn't you mention that you checked the position of the PICC. Yes! Don't assume it is in the right spot because it was already there when you came on shift. Note the chest xray.