PICC chic

MD Anderson in Houston, TX has a 3-4 day program, where you actually get to place the lines!

I lived in the US for 12 years, I am married to an american, and I still work on a work visa, just cos the green card hassel is nuts! My oldest is Canadian as well, they do not issue SSN to children of TN's until the age of 16. I do not mind the trip to the boarder once a year

I too have recently started to place the power picc, and like you I was concerned about sending the outpatients home with an open ended catheter. I have recently discovered a new cap called the maximus cap, which is the only FDA approved saline only cap. They also give a written guarantee that if your line occludes due to blood back up they will reimburse the cost of the line. I still prefer the silicone over the polyurethane. Been placing many triples in the ICU without any problems.

Here at my facility, we do not heparinize any of our lines, strictly saline only with a good postive pressure cap. Our flushing protocol is flush with 10 ml, waste 3-5 mls of blood, sample then 10 ml NS flush. With TPN, we stop it, flush with 20 mls, waste 10, draw sample. Its always best not to draw your lab from the port that the TPN is running through. As far as dressing changes, 24 hours after insertion then weekly and prn, chlorhexadine is a much effective cleaning agent then alcohol and betadine. It is alcohol first, because it defats the skin surface. When you do it second all your doing is removing the betadine!

Came across the Canadian Nursing Discussion, I graduated from the good old Misericordia back in 1993, been in Texas for 12 years, just wondering if anyone from that time era reads this thread, would love to hear from anyone

I too migrated from Canada, (Winnipeg), I was curious as to why you want Houston. I am currently in San Antonio, and there are plenty of jobs, and Canadians! It would be good to keep your options open. Best of Luck!

Just wondering if anyone out there has tried the new Bard site-rite 5, pros-cons ect. I use the old faithful site-rite 2, with a screen size of 5cm x 5cms. I saw that new machine has a 12 inch flat screen. Don't what I would do with so much visual! lol and no flicker on the screen! Would love to hear any feedback.

It has been my experience that DVT's can become noticable from one day to the next. Usually the blood slowly begins to adhere to the outside of the PICC and continues to adhere until blood can no longer pass between the catheter and vein wall and viola the arm begins to swell, and if the patient has thin arms it becomes noticable quicker.

Yesterday a pt had a massive infiltration of ct contrast, which required her to go to the OR immediately. Though is not an event that occurs often, we are now looking to take steps to see if there is something that we are not doing that we should be doing. Like where the IV is located, size and how long has it been in place. I was wondering if any has any suggestions to help safegaurding the pt from having this happen. Thanks in advance:)

I was wondering if you use a needleguide, sometimes in the beginning using a needleguide can help a whole lot with getting in at the right angle. I know that sono-site does have a probe cover with needleguides.

has any out there in the PICC world placed any 3L PICC's? I am hoping to trial some in the next couple of weeks. I am very excited, there are many patients that I PICC that could definately use a triple lumen. Just wondering if anyone has any feedback on them.

I place BARD groshong PICC's everyday and have done so for years, heparin will not clot the line! Knowing the indications for heparin, I can't imagine how she could make that assumption. You can always contact your rep for manufacture guidelines.

I am located in South Texas, and have been working as a PICC nurse for 3 years now, I had started as an independant contractor and worked for a company, I was paid 100.00 per insertion. The company charged the facility 275.00. But this company supplied all the supplies, which runs about 75.00-100.00, if you don't have to use more than 1 set. When someone doesn't have their success rate over 95% then it becomes very costly because your profit ends up being eaten up by having to use more supplies. If you were to start your own business you could absolutely charge 300.00, do all the work yourself, but once your company grows and you need more nurses to work with you, do you want to pay them all your profit? Starting your own business can be very trying, with many demands, you need to find out who your competition is and what are they offering and try to offer more or provide a better service. I have attempted to start my own business but found that I could not commit to the 7/24 pager and still be part of my families lives. Though the money is great, PICCing has to be your niche, and the patient your number one priority and not just dollar signs. I now work in a hospital making a great hourly rate and loving my job! Hope this info helps you.

I actually just track PICC's. The infection control nurse tracks other central line infections. I do about 10 out-pt PICC's a month. I would like to increase that number at some point by marketing, but the in-patients keep me busy enough!I have a part-time nurse who takes call every other weekend and covers my days off(which are not many). I have to say that my hospital does truely appreciate all that I do!

The census runs around 200, we do provide on-call weekend coverage but not for after hours. When I took this position, one of the first things I did was provide classes for the nurses on care and maintanence of PICC lines. I do try and keep up with the dressings, but some days I'm so busy inserting I don't have the time. Most to nurses are pretty good at getting them done if I don't. I also assist with difficult IV starts, I also do a fair number of PICC's on out-patients, which acutally makes money for the hospital. Reimbersument is quite good. I track all blood cultures and central line infections and the dwell time of all PICC's, it the patient has completed therapy without complications or if it was removed due to complications. Which means that I make telephone contact with all patients who have been discharged either home or to a LTAC. I compile the data into a quarterly report which administration loves! I look at it as good job security!