Mic H.

First, let me say that I wear two hats. 1) As a PICC team member at a 300 bed hospital and 2) CEO of a PICC placement business. 1. I never place a PICC alone. In the hospital I require a tech, CNA, nurse, or nursing student to be in the room during the insertion to ID the patient with me for the "Time Out" and assist the patient and me with anything during the procedure. In the various facilities my company places lines for, it is written in the contract that a non-physician medical personnel from that facility be willing and able to assist. I fine that at the moment things aren't going as planned it is not the time to have to call for help, wait for them to wash their hands and don mask, hat and gloves to assist. 2. Hospital hours for the ONE PICC nurse are 0700-1900 M-F and 0700 - 1500 Weekends and Holidays. Company hours are 0800 -1800 M-F and 1000-1600 Weekends and Holidays. 3. Indiana is one of the states that allow nurses to interpret PICC tip locations and release for use. I believe at last count there were 14 states total that allow this practice. The trick in this state is to get the radiologists and the hospital to back the idea. We all have access to the digital image and look at every x-ray, but no facility I work with right now has allowed the line to be used until a radiologist verifies the tip location. 4. It is very rare that we need to send a PICC to Interventional Radiology. Just like all the other replies, they hate to place them and their schedule is usually packed to the point that the pt. has to wait 24-48 hours for placement. MST/US has really changed things for us bedside PICC nurses.

I think the first question should be is a midline the right catheter for this patient? From the little I have read in your information this patient has infiltrates that prohibit short peripheral placement. If you place a midline in a major vessle above the AC and infuse the same fluids through it you may set the patient up for damage to his basilic or cephalic vein which would be difficult to differentiate early due to the pain that the patient is already experiencing. So, depending on what you are going to infuse the patient may benefit from a PICC line. I know that it is not yet possible to place a PICC in the home due to x-ray verification needs but the wrong line for the patient is not the best practice either. Next, if the infusates are not the problem, it may be possible to place a midline using ultrasound and MST, but without seeing the patient it is difficult to assess and again it would be difficult to differentiate pain r/t new catheter and pain r/t previous injury. Hope this helps, Mickey

It is more difficult to place PICCs in the hospitalized patient because patients are becoming more and more venous depleted. Do you use Ultrasound and Microintroducer technology to assist you in placing these lines? Is your hospital proactive in their approach to PICC/Midline placements or reactive?

O.K. this is my second try to post something. I am a better teacher than a computer user. I was told to go to "all nurses" because a name I would recognize was listed there. Let me tell you that I know this person very well. If you would like to know more contact Anne at infusion knowledge: [email protected] or go to infusionknowledge.com although I don't think the current bio on this person is listed yet.