Assessing for a PICC line

[mommagracy]

Who is responsible for assessing a PICC line and if it's a nurse how would you go about doing so?

[Daytonite, BSN, RN]

When I worked on a IV team, we often assessed and would recommend the placement of a PICC line to physicians. However, a PICC line requires a physician's order. Physicians who are educated about what a PICC line is and it's advantages will evaluate their patients need for them and order them if they feel the patient will benefit from them. We would just leave a note for the physician and ask them to consider the placement of a PICC and our reasons for doing so. We often had situations where the patients had been in the hospital for several weeks and we had exhausted all their peripheral veins. If they were getting antibiotics like vancomycin, the peripheral veins didn't last long. Reasons for a PICC include:

• anticipated IV therapy lasting a few weeks to several months
  
• administration of long term antibiotics lasting 2 to 3 weeks to several months
  
• total parenteral nutrition
  
• pain control
  
• administration of vesicants or irritating medications
  
• preferred when a patient has pulmonary problems to avoid risks associated with central line insertions (puncture of lung and pneumothorax)
  
• previously damaged, sclerotic peripheral veins that are no longer viable for IV therapy

I currently have a PICC line myself that was placed in mid-July for chemotherapy (5-FU which is very irritating to the veins). It is expected to remain in place through February. So far, it's doing just fine. It was inserted by a radiologist and nurse at a local hospital. Here is the list of instructions I was given when it was inserted

• [attach]5740[/attach] PICC Line Instructions