Embarassing Q's that I don't want to ask my instructors...

Mystery5 · Jan 19, 2005

PICC stands for periphially inserted central catheter. It is a central line inserted in the arm.

ageless · Jan 19, 2005

Flush before the med to check for patency, then push 1st med, flush again, push 2nd med, flush again. Remember that once the med hits the blood stream it moves and mixes with the circulation. Incompatibility happens when the meds mix together cause a chemical reaction and then hit the blood stream.

remember, no stupid questions...only stupid answers :)

Tweety, BSN, RN · Jan 19, 2005

Good answers from above. Don't be afraid to ask any questions.

Remember the heart beats very fast and blood circulates quickly through the body, so even waiting just a minute the first blood is into circulation. By incompatable it doesn't mean that they can't be in the body at the same time. It means you can't mix them together prior to administering them.

Good luck!

Mystery5 · Jan 19, 2005

Just remember, with PICC's and Central lines to always use a 10CC syringe to flush, because they exert less pressure on the lines. Also, with any central line you must be very careful not to get any air in the line because they empty directly into the superiour vena cava and more readily can cause an air embolus.

HillaryC, RN, CRNA · Jan 19, 2005

Just remember, with PICC's and Central lines to always use a 10CC syringe to flush, because they exert less pressure on the lines. Also, with any central line you must be very careful not to get any air in the line because they empty directly into the superiour vena cava and more readily can cause an air embolus.

Just a little note on this -- isn't the pressure exerted the same in the newer 2/3/5 cc flushes that have the same barrel diameter as traditional 10cc flushes? I believe that's the case.

Hillary

UTRN2005 · Jan 19, 2005

Central lines are usually inserted through the subclavian or jugular vein while a PICC is usually inserted in the arm (although it could also be inserted through the leg). PICC lines are less susceptible to infection at the insertion site, due to the cooler skin on the arm and less contamination from the head, neck, mouth area. PICC lines can be left in 6 mos-1 year, Central lines are usually only left in for 2 weeks. Both are considered central venous catheters because the terminate in the superior vena cava. PICC lines also generally have 1-2 ports (there is a company currently manufacturing three port PICCs, central lines commonly have up to three. The decision in choosing one or the other would be decided on the length of therapy (longer than 2 weeks?) and number of products given (ie: blood (don't re-use a port used for blood products), PCA (needs running IV solution), and intermittent antibiotics----this may be a drug profile of a trauma patient who had blood loss.)

Hope that helps---my instructor last semester worked for an outpatient IV therapy clinic so we got a lot of info on IV lines, although some of it has blurred together since then.

blue heron · Jan 19, 2005

Central lines are usually inserted through the subclavian or jugular vein while a PICC is usually inserted in the arm (although it could also be inserted through the leg). PICC lines are less susceptible to infection at the insertion site, due to the cooler skin on the arm and less contamination from the head, neck, mouth area. PICC lines can be left in 6 mos-1 year, Central lines are usually only left in for 2 weeks. Both are considered central venous catheters because the terminate in the superior vena cava. PICC lines also generally have 1-2 ports (there is a company currently manufacturing three port PICCs, central lines commonly have up to three. The decision in choosing one or the other would be decided on the length of therapy (longer than 2 weeks?) and number of products given (ie: blood (don't re-use a port used for blood products), PCA (needs running IV solution), and intermittent antibiotics----this may be a drug profile of a trauma patient who had blood loss.)
Hope that helps---my instructor last semester worked for an outpatient IV therapy clinic so we got a lot of info on IV lines, although some of it has blurred together since then.

another question then-- When you say 'don't re-use a port used for blood products', does that mean at all, or can you re-use it for further blood products?

Thanks

gn04 · Jan 19, 2005

I just graduated on 12/17/04, there is NO SUCH THING AS A STUPID QUESTION, please do not be afraid to ask any questions you are there to learn and with nursing you will be asking questions for the rest of your career because there is forever change, your instructors are there to help you.

UM Review RN, ASN, RN · Jan 19, 2005

No question is stupid. We all had to ask, too.

1) What is the difference between a Central Line and a Picc line? Why would one get ordered over the other?

After digging around in Google for a few minutes, I found this wonderful site that pretty much explains everything you need to know and with decent diagrams to boot:

http://www.mededcon.com/cvct_c.htm

2) When giving IV pushes, and you find that 2 drugs that you are about to push aren't compatable...it's acceptable to *only* flush before giving the second one, right? In my world, I flush before/after giving any med at all, even when it's compatable. It just seems to me that if you give 2 incompatable IV pushes right after eachother, and with only flushing, they will still work against each other.

For a peripheral IV, I flush with 3 cc's, give the first med, flush with 3 to 10 cc's, give the second med, and flush again with 3 cc's. I flush central lines with 10 cc's each time. The flush keeps the meds from mixing. Like Tweety said, the body circulates blood at a rate of once every two minutes. Almost all of the IV push meds you'll give are given very slowly so they won't mix with each other while you're giving them this way.

Hope that helped.

UTRN2005 · Jan 19, 2005

When you sample blood from a port/lumen, only use that port/lumen for blood sampling (ie drawing labs). The same goes for administering blood products. So you'll need to label your ports.

We used a book called Phillips, L. D. (2001). Manual of IV therapeutics (3rd ed.). Philadelphia, PA: F.A. Davis. It's a very dry, long read but LOTS of info about all types of IV stuff, peripheral and central.

Jolie, BSN · Jan 19, 2005

It concerns me that you are unwilling to ask these questions of your instructors. Are they over-bearing? Are you afraid of looking stupid?

If the former is the case, then you need to speak to your instructors and/or their supervisors, as it is their JOB to answer your questions in a respectful manner.

If the latter is the case, then get over it. As a student it is your JOB to ask questions and learn everything you can. If you have a question about these things, I assure you that most of your classmates do as well.

Students and nurses who fear asking questions are a real concern to me. They risk doing things (often incorrectly) without understanding the rationale, rather than asking appropriate questions or asking for help. In our profession, this is very dangerous.

One of the frequent posters on the peds forum has a saying after her name that reads something like this, "By all means, ask the stupid questions. They are much easier to deal with than the stupid mistakes." I couldn't agree more!