central lines protocols

[wrkoutgirl]

Just wanted to know how your protocols, practice, or experience is regarding central lines. What type of documentation do you get or expect after the line is inserted in order to safely start using it? Is it any different when it is a central line or a peripherally inserted central line PICC?

Do you get documentation about which vessel was used, the size of the catheter, how much heparin was used, and so on in both types of central lines? Do they write an order saying, "line ready to used" in either case and whether it is inserted at especial procedures department or at the bedside?

Thank you for your feedback,

wrkoutg

[Penelope_Pitstop, BSN, RN]

Well, in a code it is totally different. To push drugs in a code you have an MD ordering what to push and when, so the order to "use the line" is right there during the code.

I do realize that was a "duh," but I wanted to add it in anyway. :)

[annaRNC]

I work on peds so what we get back is an order sheet that gives the orders to flush qshift with x amount of heparin (units dependent upon patient weight either 10U or 100 U) as well as a spot that the doc checks to state that placement has been verified by chest x-ray. If I don't get that back on a kid I won't use it until I get an order from the IR doc that it's okay to use. What drives me nuts is when kids have a double lumen in the IJ and other nurses tell you that one doesn't draw but the other is fine because then you have to get a TPA order and fix it. When I've brought it up the excuse is always that they didn't want to do anything because the PICC is in the IJ. Anyone else think this is insane aside from me? The double lumen is there for a reason so one drawing isn't acceptable to me. This has happened quite a bit in the past several months.

[wrkoutgirl]

thank you so much, you are just confirming that I was right not to use and to insist on getting an order. I left the order written for the incoming nurse and I even asked him, "are you going to use it?" and he said, "yes". My pt returned with his central line an hour before the end of my shift and I spend all that time fighting for what I thought needed to be done or else. Had this happened earlier in my shift I would not have use it without an xray. I had to argue my case to several people including my supervisor and the physician. I left it all up to the next shift nurse and he did what he felt "comfortable with" ???!!

regards, wrkoutg

[wrkoutgirl]

Hi Anna, I agree with you. It is sad because there are just too many shortcuts and too many "it is ok", "no big deal" "you are too strict" and so on,.

regards, wrkoutg