Practicing to my full scope...PICC question

[gr8fulnrs]

I am an LPN who is working on a medicare unit in LTC. Resident on the unit is having Ancef administered via PICC line, using the SASH protocal (saline, antibiotic, saline, heparin). My question is do I check for blood return prior to the first saline flush, or after, or at all? Some nurses are saying I dont have check for blood return, some are saying that I do. input?

[jadelpn, LPN, EMT-B]

You are fortunate that you can deal with PICCs in your scope as an LPN, as in many facilities, this is not the case. Good for you! It is my understanding, you should always check for blood return prior to infusing. It is the first thing you do. It does happen that the end of the PICC can clot off, therefore, blood return assures that this is not the case. Ancef is a pretty rapid infusion rate, therefore, if you don't check or don't get blood return, it can cause consequences quicker than an infusion that takes say an hour. If you don't get blood return CYA and get another nurse to check with you, as some facilities have a protocol to unclot the line, though not sure if every place has this or not.

[Sun0408, ASN, RN]

I have to say also you are lucky you can touch a PICC and handle IV meds. In many states it is not allowed for LPN's. I hope you know your scope of practice just to be sure. If the PICC has heparin in it, it is my understanding and many unit policies to pull off the heparin (waste 10 cc), flush with NS then your antibiotics, then flush again then add the heparin. When you pull off the heparin you are getting blood back also, so that kinda takes care of your blood return.

[itsmejuli]

What does your policy and procedure manual say?

[wyosamRN]

Don't take this the wrong way, but if you haven't had some training that clearly defines PICC med administration, it may very well be out of your scope. I've not heard of states that allow PICC access by LPN's. Protect your license.

[MO-LPN]

LPNs are allowed to administer medications via PICC in Missouri. We're allowed to mix the med prior to administration as long as it is the type of powdered vial that attaches to the fluid bag and is then mixed. If it were the type of set up that would require drawing up saline, injecting that saline into the vial to mix the powdered medication, then drawing the reconstituted medication back into a syringe and injecting it into a port on a fluid bag, THAT - WE ARE NOT ALLOWED TO DO. We also do not push any IV meds of any kind - unless we would be able to say without a doubt in court later that it was a life or death situation. We can MONITOR blood infusions, but can not hang them. We can hang TPN if it is pre-mixed, but if it needs something added to the mix prior to administration such as lipids - we are not allowed to mix these preparations.

Your pharmacy should have an intravenous policy and procedures manual available. If you can't find it, call the LTC pharmacy, ask for the IV therapy department, tell them you couldn't find the manual, and ask your question.

You check for blood return immediately after cleansing the port, before flushing.

Hope this helps,

T

[gr8fulnrs]

Thankyou fender and thankyou wyosam! I knew you all would set me straight! I researched with my BON in Az. and I DO have to take an LPN IV and medication skills course prior to doing any type of IV therapy. I did get this information in my core curriculum in school but never have used this skills in the workplace. Now i am working in LTC on medicare unit where everyone has a flippen PICC line! Since my first post and today I have talked to my supervisor and explained my situation and they will re-imburse for the course, so back to school I go. yippee.

[systoly]

why is she lucky???

and just because you haven't heard of it doesn't mean it doesn't exist, shocking isn't it

my state allows it, but i'll be glad to let you have it

[TheCommuter, BSN, RN]

Don't take this the wrong way, but if you haven't had some training that clearly defines PICC med administration, it may very well be out of your scope. I've not heard of states that allow PICC access by LPN's. Protect your license.

I was an LVN for four years in a state (Texas) that permits LVNs to access and maintain PICC lines and central lines.

[CT Pixie, BSN, RN]

Count me as another LPN who is permitted under my States scope of practice to maintain and access PICCs. We can only do it after taking an additional IV medication and skills class.

I work LTC and we occasionally have a pt with a PICC. But they are far and few between.