PICC Conundrum

[IVRN94]

I work as a Home IV nurse as well as on a Hospital IV team. I frequently find that my home care patients are discharged without any information on the PICC ie length & tip location.

I have been careful not to initiate home IV therapy until I have verified tip placement with the hospital. I do this because occasionally I come across a line that wasn't x-rayed, I also have found lines that were x-rayed but the tip is in the atrium and no intervention was done. However, I recently was pressured by my supervisor that I need not insist on verification at home because if therapy was initiated in the hospital they would have checked placement, and the standard is to check placement prior to initiating therapy or if malposition is suspected.

I disagree with her rationale. I personally know of nurses who have no clue that placement must be verified prior to use. They ASSUME placement is correct when the patient returns form the procedure. I am not willing to risk my career on a misplaced tip.

Another part of the issue is what therapy is being given. If it is an irritant not a vesicant, or just long term therapy, how much does it matter? ie line does not need to be a CVC, midline would be appropriate.

Please give me your thoughts on the issue. I am seriously considering leaving home care because I feel a lack of support, and am put in situations I feel put patients at risk.

P.S. anyone who knows of any articles on this issue please let me know.

[bobbiern]

I just placed a PICC today and felt it went right in. I had absolutely no problems. An xray was ordered and to my dismay the PICC had been curled in the axillary vessel. I feel all PICC insertions must be determined by xray especially if your doing it without US guidance. I have placed PICC's for approximately 15 years and have never had this happen. I had left the hospital and was on my way back when the physician pulled the PICC with research I found you can reposition the PICC if you use sterile technique. Now the patient has to go through the procedure all over again.

[caliotter3]

As someone with little to no experience in this area, I refused to take on a case such as this with a very small baby. The supervisory nurses were trying to browbeat me into taking the case and the non-nurse business manager was hanging on every word they said, trying to make me look incompetent and uncooperative. I had to inform the business manager of the legalities of exceeding my scope of practice and my abilities. To this day, I don't think this person ever "got it". I will never involve myself with a procedure in the home that I am not capable of performing. When I see something looming in the distance, I inform my supervisors and let the chips fall where they may.