missdubbie

hello, hope you are having better sleep now that you've got lots of information. it may seem very obvious but if you've still got your bard workshop book, you'll find all your answers there. are you inserting the piccs peripherally or with ultra sound as each would give you different lengths to insert (the higher above the ante cubital fossa you go, the shorter the length to be inserted. this is how i measure my lines asuuming i'm using a peripheral cannula (therefore belove or just aboce the acf),with the arm at 90 degrees, measure the distance from the insertion site to the head of the humerus across to the sternoclavicular junction (bard). in miss dubbie's language-measure from the chosen vein site to the sternal notch, from the sternal notch to the lower third intercostal space and the total of both measurements is the length of line i insert. **i was taught to add extra 2-3 cm if using the left arm for same reasons explained earlier in the forum. re documentation- bard has a sticky label in the picc pack all you need to fill in is the lot number, date of insertion and name of clinician. in the medical notes, i always make sure i include the following: consent local anaethetic used what skin is cleansed with number of attempts before successful picc insertion amount of bleeding back flow/ability to confirm placement lenth of picc inserted lenght of line cut off 9(if applicable), length of line from exit to hub medications and flushes administrated, strength of heparinisation 9if required) type of bung/cap used dressing used. then in bold letters, i write :chest x-ray ordered to confirm correct position of picc before use. dressing to be changed 24 hrs post insertion (***please apply pressure pressure dressing if excessive bleeding noted but leave dressing in situ for 24 hrs). dressings to be changed every 7 days please unless otherwiae indicated. do let me know if i've missed anything- best thing about this forum is we learn from eachother:idea:

Shame we don't have any security officers on this site (yeah yeah yeah i know this is a forum for nurses but............) ooooooooooooooooooooohhhhhhhhhhhhhhh the stories. I had the priviledge of checking some of their cctv footage and ooooooooooooooooo mmmmmmmmmmmmmyyyyyyyyyyyy gosh!!!!!!!!!!!!!!!!!!!!!! IN the hospital where I work, the morgue, the medical school library and the back of the accident and emergency department that are the hot spots for all the extra curricula activities; a real multi disciplinary team:lol2: pray tell the interest in this area!

You did the right thing by flushing! Please continue to flush in between any medications with either water for injection or normal saline (as per your local policy). If not, as you quite rightly said, you'd be administering 2 drugs together. What if the 2 drugs are incompatible? Working in your department carries a lot of pressure and demands accuracy because even though the patients are dying, it's how, why, when,what and who that the relatives and managers jump on. Similar to adding normal saline with Cyclizine and Midazolam in a syringe driver for a dying patient (incompatible- attributed to patient's rapid deterioration and nurse responsible ended up filling an incident form, retraining on iv giving study day and supervised practice for 6 months). I hope this has laid more emphasis on your question. So in the absence of any written policy,with the exception of ILOPROST VIA PERIPHERAL CANNULA, I will flush in between medications. Remember- safe practice is best practice!!!!!!

Thank you for the supportive words! I just figured out how to reply to you so do forgive me if you have to read this twice. As I said in my reply, I do have a background in infectious diseases, haematology and oncology. I don't prescribe yet but my medical team and I work closely in decision making based on patients crp, lfts, u&es, fbc etc. It becomes quite interesting when we have to argue about doses especially when I'm right (sometimes):wink2:. Again I say thank you for your support. Missdubbie

Hello all, I thought I'd introduce myself to you and the services I offer in the hope that should you come across anything of interest to me, you'll keep me posted. I am based at the Royal Free Hospital (NHS Trust Hampstead). PATS was formerly known as OPAT but was changed to PATS due to the wide variety of clients I see. My primary role is to assess clinically stable patients and teach them or their carer how to administer intravenous medications (antibiotics, antifungals, antivirals, chemotherapy, electrolyes- to name a few). Conditions I treat include Endocarditis, Osteomylitis, Vipoma, HIV/AIDS, Leukemia, UTIs and any condition that patients can live in the community with safely. Most of the patients have Hickman lines and I insert peripheral cannulas for those on short term (4-7 days) treatment. I am currently being assessed to inser PICC lines. It's an exciting service which is saving the Trust about 5-7 bed days weekly. I am in the process of writing my SOPs and would be more than grateful if any of you could help me. Here's to looking at a highly interactive thread!