pacemakers and picc

Hi Redkat, I had a similar situation last week. I am new to PICC insertions so I deferred to my preceptor who sent the pt to IR...we didn't even attempt it. During our ultrasound assessment of the vessels, we noticed that they were all very small. Had we seen a huge gaping basillic, we might have gone for it. But, the preceptor rationalized that we should preserve the vessel for IR.

On another note about pacers and PICCS, we found very little information existed in our literature search.

Hi I was wondering what is everyone's hospital policy or thoughts on picc lines being placed on a patient with a pacemaker on one side and defibrillator on the other side of the chest. Just had a patient with that scenario. But supposedly the pacemaker was old and not functioning. I recommended patient go to radiology for the picc. Any comments? Thanks

Yes, you have a problem here!

My first question would be, "When was the pacer placed, and the defib placed?" Now, you say the pacer was old and non-functioning, "Why, oh why haven't they pulled it?" I wouldn't have a hesitation placing the PICC on this side, but I would have concerns that once placed, the "old" pacemaker with its considerable fibrin buildup will cause a fusion between the PICC and the pacer leads and once one is removed, fracture may occur. Most cardiologists like to wait for 6 months to pass after a pacemaker is inserted and before a PICC is placed, but find out what your MD's say in your place of employment. You want the time to lapse so the leads can become emedded into the cardiac muscle. There are many PICC nurses who do defer to IR so this can be done in real time.

Same here IVRUS....6 month wait for inserting on the ipsilateral side. However, in the pt I did last week, the pacer was 3 days old and the cardiologist still cleared me to insert PICC , but on the contralateral side. I still ran into probs dropping the line as we kept bumping into the subclavian central line already in place. It was quite the learning experience. LOL

We don't do piccs on the side of a defibrillator or pacemaker so this pt would not be a picc candidate for us