i have recently started placing picc lines in the ltc setting, and i have found that they don't stay in very long. i have been placing piccs in the acute care setting for a few years, and while the unintended removal of a picc has always been my #1 complication, it never happened as frequently as it is in the ltc arena. most of my piccs in ltc are "fall out" before they are supposed to.
i have tried several things: extra securement, extra tape, wrapping the arm in kerlix, using spandex netting around the arm. nothing really seems to be working.
Specializes in Gerontology, Med surg, Home Health.
I've only had trouble with PICCs at one facility I worked in. Seemed for some reason the pharmacy changed the flush protocol to something stupid like 1cc 10u heparin. As soon as I arrived and they told me their lines were always occluding, I called the medical director and changed back to an adequate flush....no more problems.
Specializes in LTC,Hospice/palliative care,acute care.
Sounds like these nurses and cnas need some inservicing. These things just don't pop out and throw themselves on the floor. Poor transfer, bathing and dressing technique is how it looks. Restraints are totally not necessary.
I've never seen a PICC "fall out" or be pulled out by careless staff...I have had many a demented resident pull them out....In my experience if it's out of sight it's out of mind.....I generally wrap with kling,apply a skin sleeve and we make sure the resident is wearing a long sleeve shirt and usually a sweater,too.....We do one on one during an antibiotic infusion......We'll put them to bed with a long sleeved sweat shirt on also.....Sadly it still does happen-many of our PICC lines are placed in residents that should probably be on hospice-we have many un-realistic s.o.'s.......
I have been placing lines in LTC for several years and have experienced the best success in confused patients using some form of catheter securement device, an occlusive dressing, some tube-a-grip stocking window over the site and a long sleeve shirt where the sleeves are cuffed (like a sweat shirt) including at night. The 'out of sight, out of mind' theory works the best, but if they want it out they will get it out. We use midlines whenever appropriate because this problem and always ask for doctor's orders to reinsert so the physician can reassess if the therapy should be continued IV or could be changed to a different route. Usually our oriented patient report they caught the line on something and it came out. Using tube-a-grip on these patient's also helps.
Wow, never seen PICC lines used in care homes over here! We would def need in house training first, but then again we rarely even use subcu fluids never mind IV ones over here!
Specializes in Nursing Home ,Dementia Care,Neurology..
We use subcut and the occational p.e.g but I've never seen a PICC in the Nursing Home setting,generally if they need something like that they are transfered to the local hospital.Would be interesting but a nightmare to keep safe!
I am curious on how or where you can get hired to do PICC insertions in ltc and how is it done there is how is the chest xrays done for confirmation is the residents sent to hospital for this? just curious.
Specializes in Gerontology, Med surg, Home Health.
Wee've been using both MID lines and PICC lines for years. The type of line depends on the medication being used and the length of therapy. Honestly I prefer them to peripheral lines because they can stay in for months if cared for properly.
I had a PICC line once for 3 weeks of antibiotic therapy after a serious case of cellulitis.
It was not a painful procedure and I went to work with my little fanny pack filled with IV augmentin. My arm was quite painful however for months after they removed the line so if your demented resident is acting out after the PICC line is removed, you might want to give them some pain medication.
And yes to the last poster...most of the time the IV team will opt for a MID line, but if they insert a PICC of course we must get a chest xray before we use the line.
Specializes in ER, ICU, Infusion, peds, informatics.
i am curious on how or where you can get hired to do picc insertions in ltc and how is it done there is how is the chest xrays done for confirmation is the residents sent to hospital for this? just curious.
i guess it depends on the area of the country, but we had a mobile xray company come out and shoot the film, then give us a call report.
sending them to the hospital for the xray would negate some of the benefits of having a nurse come to the facility to place the picc.
as for getting hired to do them in a nursing home, for me personally it was just part of the job i had placing piccs. i worked for an outpatient iv pharmacy, and picc placement was one of the services they offered. i placed them in people's homes, too.
some rehab centers in my area will hire picc nurses on a prn basis rather than contracting with a company -- really just depends on their volume.
CapeCodMermaid, RN
6,092 Posts
I've only had trouble with PICCs at one facility I worked in. Seemed for some reason the pharmacy changed the flush protocol to something stupid like 1cc 10u heparin. As soon as I arrived and they told me their lines were always occluding, I called the medical director and changed back to an adequate flush....no more problems.