Do you need an "OK to use CVC/PICC/port" order for an old access?

[KaeliF]

I know you need one before you can access any NEW central line or PICC or port, but if a patient is admitted with an old one do you still need the order before you can use it?

[Anna Flaxis, BSN, RN]

Policies vary from institution to institution. Check your facility's P&P.

In the acute care setting where I practiced until recently, for ports and PICCs placed prior to the current admission, you needed an MD order to access a port, and for a PICC line, you needed an MD order and radiographic confirmation of tip placement prior to use.

[RNsRWe, ASN, RN]

What Stargazer said.

Facility I last worked in wouldn't allow anyone to use an established line for any newly-admitted patient: didn't matter if WE put the line in and sent the patient home a week ago. New day, new order needed....with line placement VERIFIED.

[blondy2061h, MSN, RN]

My facility's policy is that if we placed it and we can see the old order in the EMR and the patient denies any issues with it (pain, pulling), we can use it. Placed at a different facility we need an order.

[MunoRN, RN]

What Stargazer said.

Facility I last worked in wouldn't allow anyone to use an established line for any newly-admitted patient: didn't matter if WE put the line in and sent the patient home a week ago. New day, new order needed....with line placement VERIFIED.

I'm curious how this works with outpatients, do they have to have placement verified for every visit for a dose of antibiotics? Why would the concern for line displacement be any different due to whether or not they are coded as an outpatient or inpatient?

[Anna Flaxis, BSN, RN]

I'm curious how this works with outpatients, do they have to have placement verified for every visit for a dose of antibiotics?

When we admit a patient to our service, we require verification of catheter tip placement, which is usually just a copy of the transcript from the bedside x ray at the time of placement. At each subsequent visit, catheter patency is assessed (can you get blood return, does the line flush briskly, has the external length changed, is the patient reporting any symptoms a/w tip displacement, etc). At the end of service typically 6-8 weeks later, the PICC line is pulled and the patient discharged from our service.

For ports and tunneled lines, we typically maintain those over an extended period of time, so assessments are done regularly, and appropriate action taken for any concerning findings, whether it be tPA, an x ray, or a dye study. The patient is still on our service for port/line maintenance.

Why would the concern for line displacement be any different due to whether or not they are coded as an outpatient or inpatient?

It's not, really. It's more that there is an interruption in service. In the outpatient setting, if a patient were discharged from our service and readmitted at a later date with the same line in place, we would require confirmation of tip placement to rule out displacement in the interim, when the patient was not on our service receiving regular assessments from us.

Think of it this way; in the hospital, you don't get a chest xray to confirm placement before every use, but rather, only at the start of service. Each separate admission is a separate episode of service. Same in the outpatient setting.

[KaeliF]

Well now I feel silly just went over my central line policy again and I found it. It doesn't say anything about needing an xray verification for an old line though, just the order.

[tamadrummer]

Yes we need an order to access any central/midline. There are signs hung in every room informing the patient that they should expect the phlebotomist to stick them regardless of having a line. It also explains how easily bacteria is spread into to blood through the use of central lines

[hiddencatRN, BSN, RN]

Policies vary from institution to institution. Check your facility's P&P.

In the acute care setting where I practiced until recently, for ports and PICCs placed prior to the current admission, you needed an MD order to access a port, and for a PICC line, you needed an MD order and radiographic confirmation of tip placement prior to use.

This. I have one job where you need the order (although the culture is you go ahead and do it and then get the doc to write the order after if there's something STAT to be done, like abx for chemo + fever) and another place where it's considered a nursing action to access a central line or port, no doctor order needed at all.