coronapeng

The biggest thing to remember about midlines is that you don't want to give vesicants through it (any drugs with a ph9 or an osmolarity>500). Most antibiotics that are given long term do not meet this criteria. Manufacturer recs say that dwell time should not be more than 4 weeks. I know that midlines are used a lot in nursing homes and home care as they are less expensive, but I would be very cautious about how you use them. Because the tip resides deeper than a peripheral more significant damage can occur before it is detected. With the scenario that was mentioned, as long as the pacemaker had been in for at least 4 weeks and it was ok with the cardiologist, I would have placed a PICC on the side of the pacemaker.

We have been using the Power PICC for almost 2 years with very little problems. We started using the 6 Fr dual lumen and the 5 Fr single. We have switched to the 5 Fr dual and continue to use the 5 Fr single. It is practically the only catheter we use. The catheter is made specifically for contrast injections. It can withstand multiple contrast infusions over time. I would not worry. Even if a pt is going home on abx, we still use the Power PICC. The risk for air embolism is so small and I am not aware of any actually that have been reported. Pts go home with open-ended catheters all the time. The problem to worry about is clotting. You need to make sure staff knows how to adequately flush to keep lines patent. As for placing the lines we have realtively little trouble getting them to go to the SVC. Generally we place the pt's HOB about 20 degrees. We only raise the head up as a last resort. Bring the arm out as far as possible. Pull wire back 3-5 cm. Slowly feed catheter. Have the pt turn their head to the side of insertion as far as possible and then chin to chest. Flush with 20 ml syringe while inserting catheter. All those usually work for me, but I have the added benefit of using the Navigator now!! On a few occasions we have actually placed the pt in trendelenberg and/or raised the arm up above the shoulder. It is rare for us to have to send anyone to IR. We have had a month or two where it seemed we ran in to trouble way too often. I think it just depends on what kind of pts you are seeing and if they have had multiple lines. We started keeping a list of the pts we can no longer get a line in to! We have not started using the triple lumen yet, but it is in the works! Good luck.

We have been routinely using the Bard 6 Fr Dual Lumen Power PICC with very few complications. It has 2 18g lumens. We use ultrasound and MST for all placements. We are just about to start placing the 6 Fr triple lumens (1 lumen is 17g, the other 2 are 20g). Occasionally we place a single lumen for patients going home. PICC placements were started at my facility for TPN many years ago. We are now doing close to 1500 / year.

You can also suggest giving FFP if it would make the MD more comfortable. As I said before we don't have ANY cutoffs for labs. Not even platelets. we have placed one where the platelets were 15. I only place lines in a hospital, so i can't speak to home placement, but that would be one place I might be hesitant to place lines under certain circumstances. I always keep surgicel on hand just in case!

I have been placing PICCs for over 3 years now. We are doing 1500 - 2000/year bedside placement. We NEVER refuse to place a PICC based on abnormal labs. It is much SAFER to place a PICC in the arm, than a MD to place a line in the neck or chest. You can control the bleeding, if there is any, with a pressure dressing and/or surgicel. The highest INR I have seen is 9.0. Had no compications with placement and very little ooze from the site.

I work in Dallas as a PICC nurse. I know an agency in FW called Prentice Infusion Consultants. The owner is Jennifer Prentice. Her email is: [email protected]. She is very nice and helpful. She may be looking for help. I'm not sure.