Central line question

[JustMe]

Our PICC nurse uses an ultrasound machine to locate veins for PICC placement. One day, in our CICU, the cardiologist asked the PICC nurse to place an introducer so that he could later place a pacer wire through it. The nurse used his usual location--the brachial vein. My question: is this proper for the PICC nurse to place an introducer for the MD? When the MD does it, they use a jugular or subclavian vein. I guess they don't get paid by the insurances anymore for placing these central lines. Am I concerned about nothing? Am I splitting hairs? Just asking---

[SFRN]

Hmmm I have NEVER seen an introducer in the brachial vein. If I were the PICC nurse I would not feel comfortable putting in an introducer. Interesting to hear what others have to say.

[PICC ACE]

I see different sides to the issue. First,from a strictly venous-access related standpoint,there are some potential problems with this. There is the issue of scope of practice which would be a state board of nursing decision coupled with facility policy. There is also the issue of off-label use of a product--the nurse probably used a small,PICC-insertion type "introducer" rather than a big Cordis,right?

That being said,there are plenty of RN's in cath labs and radiology that are the ones placing the intro's and sheaths for vascular procedures--maybe your PICC nurse has experience and competency in that sort of thing,so placing an intro in the arm for pacer wires isn't too different. And as for off-label uses of a product,I know it happens all the time and in critical care situations sometimes you gotta do what you gotta do. If there were compelling reasons not to use the IJ or SCV route,you could still get the electrode to the heart via the basilic or axilary vein. Or EJ,for that matter.

So,would I do it? It would depend on the circumstances. I have had to do some unusual and unorthodox accesses both as a PICC nurse and as an ICU nurse. IF the best or only veins available were the upper arm ones and IF my placing a small intro there was going to make the difference between a perfused patient versus a code and IF the MD was there ready with the wire and pacer,I'd probably do it. However,the situation you describe doesn't sound quite so urgent,if the MD was going to come back "later" to place the wires. In that case,I'd probably pass.