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PICC ACE's Latest Activity


    New CL placement technology

    I,too,would be interested in hearing of your idea and helping in any way I might. PM me. Zed
  2. This should be a fairly straight-forward study,especially since it sounds like you are limitting it to one floor. First of all,do plenty of Googling and medline research so you don't waste time 'reinventing the wheel'. This should also give you ideas on how other phlebitis studies have been set up. Next,make sure you become very familiar with the phleblitis scale as described in the INS SOP's. Then you need to decide when and how frequently to assess the IV sites on the patients to get a large enough sample to be significant. Will you be able/need to do it every day for a 3-month period,every Tuesday AM for a few months,etc. This will establish your prevalence. (I would not leave this data collection to the floor nurses as they generally,and sadly,lack the experience and training to evaluate such things accurately and consistently.) The factors listed by iluvit should be included in your data collection (for all pt's,not just those who show any evidence of phlebitis) for you to draw meaningful conclusions from your study. Good luck, Z.

    Do you like your IV Pump?

    I hate Alaris. The med library and programmability are good features. The actual mechanics of the set-up are bad,however. We have innumerable problems with air alarms--the design of the tubing is such that it is impossible to eliminate some of the little air bubbles and the pump will alarm for the minutest little bubble. More than once I have had to just pitch the whole tubing set and start over. It should not take 10 to 20 minutes to get an infusion running properly,especially in an ICU. Furthermore,the piggyback sets are sometimes unreliable and will not infuse at the rate you think you have them set at. Finally,I have had more than a few Alaris 'brains' whose buttons go bad--that is,I will hit a button once but it registers as two pushes. So "100" can turn into "1000". GRRRRR Z.

    PICC line RN

    here's a contact for you--fl network for assoc for vascular access: florida association for vascular access network (flavan) chris cavanaugh ccavrn@cfl.rr.com 321-230-7860 would be a good one to contact for fl-specific questions. z.

    Malpositioned PICC line question

    This situation exemplifies two additional aspects of central line placement. First of all,the statement "line OK to use" or "line in good position" is useless. How does a rad know that a line is OK to use? OK to use means not just with tip in proper position but also with good blood return,not plugged/ruptured/defective,not stuck through an artery into the vein,etc,etc. Also "in good position" means different things to different people. Define "good". "Good" for a knowledgeable interpretter of line CXR's means "lower 1/3 of SVC at or near the CA juncture" (SIR,AVA,INS). "Good" for anyone else might be anywhere from rt ventricle to contralateral IJ to aortic arch (seen 'em all). What I want to know when I read a CXR report for line placement is where the tip lies anatomically,e.g. "lower SVC 1.5 cm above CA juncture". That,plus MY assessment of the line's patency and function is what makes a catheter "OK to use". The second issue is the importance of getting a repeat film after a significant line adjustment.A few years ago,there was a tragic case in Pennsylvania. A neonate had a line placed and the initial reading was that it was too low and needed to be pulled back a few cm. Either no one actually adjusted the line or there was no repeat film,and the line eroded through the atrium. Results-ruptured heart--tamponnade--dead infant--big lawsuit. Moral of the story? Reshoot after an adjustment.

    Malpositioned PICC line question

    Any central line,including PICC's,can indeed cause arrythmias if placed too deep. The tip of the line may "tickle" the heart tissue enough to trigger something. If the radiology read was to pull back 6cm,the line may have been much too deep,but the issue of optimal placement unfortunately vfaries from rad to rad. ST changes are associated with repolarization or perfusion issues with the ventricles--iscemia,injury,strain,etc. These changes would be unlikely to be related to a central line/PICC tip in the atrium. Kudos to your staff for getting the line properly adjusted! Z.

    CVP's before x-ray line confirmation

    Agree with all the above postings on attaching a transducer--no problem at all to do so. Furthermore,it is also our practice to draw labs from a line that has yet to be x-rayed. Just no infusion of meds until placement is confirmed. Z.
  8. The ISMP recently put out an updated list of what they have determined to be "high-alert" medications. That is,medication which have a "heightened risk of causing significant patient harm when they are used in error". The list is a long one and pretty much includes everything given in an ICU from paralytics to pressors to even KCl. One of the recommended strategies for improving safe administration of these meds includes a redundant manual double-check. (If you want to see the list,go to : http://www.ismp.org/ and find the high-alert medication list.) My hospital's powers-that-be decided to make our jobs even more infernal by requiring us to have a second person not only sign off on the med but go to the room and actually witness the med be hung,the pump programmed,follow the tubing to the patient,etc. Made for an awful lot of ticked off nurses,as you might guess. We are trying to overturn this policy change,but not look like we are ignoring the need for patient safety. I would like to hear from others what their hospitals have done about these medications. Thanks, Z.

    Anyone else studying for CCRN exam?

    Dang--that was one hard-a$$ test! Passed with 118 correct. I used the Dennison book and the Ahrens book. Will agree with above comments on Dennison book and CD--book is WAY too much and in outline form. CD is good way to practice and underestimated my actual score. The Ahrens book was easier to read but it,too,has its share of typos in the quiz answers. My scores on the practice tests in that book were closer to actual. The one reminder I have is to read the questions CAREFULLY---hypokalemia and hyperkalemia and hypercalcemia all look the same after staring at a screen for an hour. I went back and rechecked every one of my answers and good thing I did cuz I made some silly mistakes the first time through. Good luck to the rest of y'all. Z.
  10. PICC ACE

    FFP question

    FFP has no cells--it's the noncellular component of blood,so no worry in that regard. In nonemergent situations,FFP administration rate is 10ml/minute,so a 300-ml bag would go over a half hour. In an emergency,you can slam it in. In other cases,it is given as a continuous infusion,at say 50-150ml/hour. Very situationally dependent. Your blood bank should be able to provide you with more details and assistance,but a 300ml bag over an hour should be fine. You could also check with the MD about his/her preference for when the Furosemide is given--i.e. before,during or after the FFP. GL, Z