Picc Lines

Remember that all veins eventually lead to the heart. So yes the veins are used for PICCs, not arteries. It doesn't necessary have to the be a/c vein per se, any large vein in the area can be used. I see them placed both above and below the a/c, but usually above. Actually because the a/c bends, it's best not to use that area. Mind you I'm not the expert either.

The catheter inserted is long enough to reach the subclavian right to the heart. X-rays confirm placement.

As far as I know on this side of the world, we don't deal with PICC lines. But, I am sure it is done...you know how it is; everything is okay until something happens. I'd be interested in learning maintainence if I had an opportunity.

At my facility, PICCs are insterted by specially trained RNs into either the basilic or cephalic.

LPNs are allowed to flush, hang maintenance fluids and IVPBs, but we are not allowed to do any IV pushes through any central lines.

I'm not sure if I missed something during the lectures on PICCs & the veins in the arms, or if it's because the time is 3:02am and I'm still wide-awake yet should've been sleeping hours ago, but since when are PICCs inserted into the antecubital vein? I've only & always seen them above this site which, if my anatomy knowledge is still intact, would place it at the cephalic or basilic vein, right?

If I'm wrong, then please disregard this post. And thank you for clarifying regardless.

Yes, I believe you are correct. There is not a "antecubital vein" but rather two veins that run in the AC area--the cephalic and basilic. The cephalic runs laterally and the basilic runs medially. Either of these veins are acceptable for a PICC line.

By the way, as another poster mentioned, a line inserted into an artery would be an arterial line, not a PICC.

Unfortunately, I know of a case wher a PICC has been mistakenly inserted into an artery.

And apparently was missed for quite some time.

The nurses on the unit received a checklist of things that would cue you into the fact that a PICC might be in an artery (bright red blood, pulsing when you were drawing labs, etc.)

Personally, I think that should have been caught when X-ray was supposed to verify placement. . . . .

scary. . . ..

kcalohagirl said:

Unfortunately, I know of a case wher a PICC has been mistakenly inserted into an artery.

And apparently was missed for quite some time.

The nurses on the unit received a checklist of things that would cue you into the fact that a PICC might be in an artery (bright red blood, pulsing when you were drawing labs, etc.)

Personally, I think that should have been caught when X-ray was supposed to verify placement. . . . .

scary. . . ..

Oh, wow. You'd think the pulsating blood might have been a clue...

I work for the VA in Boston and here LPN'S when trained can insert remove, and maintain PICC lines.

In MO Iv-certified LPNs can maintain (flush, do dressing changes) a PICC line, but we can not place nor dc one.

I work at a skilled nursing facility. If we have a patient who has an order for PICC line placement, we are to call our outside contracted pharmacy, and they'll send us a trained intravenous nurse to insert the PICC line. I, and the other LVNs at my facility, are permitted to maintain their patency, flush the PICCs per protocol, and give most IV meds through them. The RN does the PICC dressing change every 72 hours.

ditto, to what commuter say but the only dif is that i can change the dressing q 72

I just got my basic and advanced infusion therapy certifications here in IL. I was also just reading the nurse practice act but don't see anywhere were an LPN can either initate an IV or monitor one. I know LPNs here are not allowed to do IV pushes or hang blood. I am curious if say a facility you work for wants you to start an IV and the nurse practice acts says do not, what would be an appropriate action for the LPN to take... I'm a newbie... still searching for my first nursing job, just relocated to the windy city:)

Hi- Where I am, we can flush, draw from, maintain and hang, and change the dressing.

I just got my basic and advanced infusion therapy certifications here in IL. I was also just reading the nurse practice act but don't see anywhere were an LPN can either initate an IV or monitor one. I know LPNs here are not allowed to do IV pushes or hang blood. I am curious if say a facility you work for wants you to start an IV and the nurse practice acts says do not, what would be an appropriate action for the LPN to take... I'm a newbie... still searching for my first nursing job, just relocated to the windy city:)

When you said "I was just reading the nurse practice act but don't see anywhere where an LPN can either initiate an IV or monitor one", were you referring to PICCs or any kind of IV?

Now to the question at the end of your post: if an employer asked a LPN to perform a skill (that the nurse knows is) outside their scope of practice, I'd think the appropriate response would be for the LPN to refuse, while providing a detailed explanation supported by written proof. The last thing you want happening is to jeopardize your license for the sake of a facility. As I see it, the job is replaceable, an employee is replaceable(in the eyes of the employer).....but one's nursing license is not.

(Hopefully that made sense)