PICC question

[JustMe]

Our PICC nurse uses an ultrasound machine to locate veins for placement of the central line. One day, in our CICU, the cardiologist asked the PICC nurse to place an introducer in a patient so he could come in later and place a transvenous pacer wire through the PICC. The nurse used his regular location--brachial vein--and placed the introducer. My question: is this proper for the PICC nurse to be placing a PICC line (actually an introducer) for use as something other than what it was intended? When the MDs place introducers for pacer wires/Swans they use a jugular or subclavian vein. I hear they are no longer paid by insurance to place these lines, but does that justify asking an RN to place the central line? Is this splitting hairs? Am I concerned about nothing? Just asking---

[iluvivt, BSN, RN]

The nurse probably just accessed the vein with an IV catheter. When using a microintroducer there are several ways to gain access to the vein. One is to use a standard catheter over needle device and the other is to use a standard hollow needle and both have to be long enough to reach the vein. Once accessed a wire is threaded through that and a microintroducer is slid over that and into the vein. We have been asked many times,mostly by radiology to place a standard CON device into these veins. I see nothing wrong with this as the RN worked within their scope. I am assuming from your post that the MD did not thread anything through the PICC and the MD used the vein to place the pacer wire and not the RN. Again,this is a situation in which you must weigh the risk to the patient vs the benefit. Perhaps for physical or pathological reasons a more traditional approach could not be used or simply another vessel was attempted and could not be accessed. What were the circumstances if any that you are aware of? One other important thing to remember that US is relatively new technology at the bedside for vascular access. Yes we are learning how and in what circumstances we can use it. Just the other day my co-worker left lunch to help an MD access a deep femeral vein for an urgent dialysis catheter.