PICC insertion post Pacemaker placement

[Madam PICC]

Hello,

I am a PICC nurse with 6 years of experience in placing PICC lines. I do not currently place a PICC line if a pacemaker; ie new wires, has just been placed. I was informed this several years ago by a cardiologist and it has just stuck. Recently a cardiologist wanted me to place a PICC line in a patient who just the day before had a pacemaker with new wires placed. She said that they would write a note in reference to this and to come and place the line. I consulted with IR where we currently send these patients too because they have the capability to visualize the catheter going through the vein and so can avoid dislodging these wires. They said if the PICC team has this policy then so should IR and that it would not be a problem to place the line blindly and to place the line at bedside. I basically refused to place this line stating it was unsafe to place blindly into the chest and the PICC could potentially malposition these wires and that a two week wait is required. I even offered a midline to the Dr and in two weeks we could exchange this line for a PICC for the rest of the ABT therapy if needed. Bottom line I held my ground and would not give into their demands. The Attending got very angry and decided to place the line himself, however he couldn't because the catheter would not thread. So any way the question is what is anyone elses policy on placing PICC lines with fresh pacemaker and fresh wires? I say fresh wires because if the wires are not changed and just the pacemaker itself is only changed I will place the PICC it is only with the new wires this rule applies. What are your thoughts?

[iluvivt, BSN, RN]

We will not place a PICC on the same side as a new pacer either............we wait approx 2 weeks.if for some reason they only have that side to use we ask IR to place b/c they can visualize under fluoro..and they will do that///// let me do a little more checking for you and I will see what others are doing

[picclineman]

As long as the line is placed contralaterally to the pacemaker, i guess is okay and i do it all the time. Cardiologists can give you an order but if it is your policy not to do it then i guess you are right. You should have shown the cardiologist the written hospital policy and i would guess he will go along with you. I have asked around if there is a published article on this subject matter and i have yet to find it.