Lynstat1

Toni, you absolutely deserved every accolade you received for calling out this”doctor”. He destroyed many lives with his incompetency and arrogance and I have always admired you for your bravery and advocating for both the patient and your staff. ?

With respect to home care nurses, The INS 2011 (http://www.rcn.org.uk/__data/assets/pdf_file/0005/78593/002179.pdf, p.83)has an algorithm pertaining to persistent withdrawal conclusion strategies. However I strongly agree with the other posts that suggest investigating this issue further and the need for tPa, a line-o-gram etc to confirm that correct tip location.

Where I work, I think the tip location is what guides the position, with the tip located just below the axilla.I'm not aware that we restrict the use of the cephalic vein. However in the Paed hospital that I work at, PICC lines are the temporary central line of choice, although I have seen midlines used on the CF kids in the community.

Thanks so much, that would be fantastic! I have considered a Masters/PhD in this area, focussing on the Paed population. From all I have read, it makes sense to me that it is the mechanical action of correct flushing technique (depending on the bung ie positive, negative or neutral) that maintains line patency

Thanks Asystole, and sorry about the paragraphing, I'm new to online forums! Anyway, I too prefer the stat locks, however it's the anaesthetic team who decide what securement device is used. We are actually liaising with the anaesthetic team about this issue (Griploks placed within close proximity to the insertion site), however it takes time, I guess.

Hi There, I'm a Paeds nurse in Australia and was hoping to hear some strategies involving PICC dressing changes on children focussing on the following;1. Removal of the Tegaderm/IV 3000 semipermeable dressing. We currently use a product called Convacare which is an orange oil impregnated swab that we rub around the dressing site as we peel it off. I also use the manufacturers directions for removing the IV 3000( stretching the dressing first before removing it from the skin). I find this can be a time consuming and anxiety provoking ordeal for some children, and although we use distraction techniques and all forms of "nurse whispering" with the kids, it would be FANTASTIC if anyone new of a product that would safely remove this dressing as quickly and as painlessly as possible.2. Once the top dressing is removed, the Grip-lok (see link below for more info on these) needs to be removed. Now if anyone has a technique for safely removing these contraptions while remaining sterile on a 3-year old who is not happy about having this done, with the insertion point at the brachial vein (ie under the upper arm), while trying not to dislodge the line, I would be so happy to hear from you! We are finding that the anaesthetists are placing the grip-lok about 0.5 cm away from the insertion site on PICC lines. The INS (2011) states that securement devices need to be changed on a weekly basis, and that is the policy at my hospital as well. However these devices are difficult to work with, especially when they are place so close to the insertion site.....I find the risk of dislodging the line and maintaining sterility is quite a challenge. Consequently, we don't change the secure meant devices as often as stated in our clinical practice guidelines if the risk of dislodging the line is too high. An issue for me is if the grip-lock has old ooze/blood on it and the insertion point can't be visualized, but there is a very real risk of losing the line, would you change it?Some nurses I've spoken with have said that because the grip-lok is under the sterile dressing then it is sterile and doesn't need to be changed even if the grip-lok has significant old blood on it. Also some of these kids are on continouos antibiotic infusions, so I have also heard nurses rationalise that the IVAB's will "protect" against the risk of a line infection. What are your thoughts? Does anyone know of any evidence/literature specifically addressing old blood under a sterile dressing and the risk of infection? Where I have worked previously we had to do a dressing change on a PICC line 24 hours post insertion, however the securement device were stat-loks and they placed about 3 cm away from the insertion point, so dislodging the line was not a huge issue.Please remember that I'm addressing the paediatric population with these questions. For adults I would not hesitate to do a dressing change if there was blood present etc on the dressing. Also we have quite advanced distraction techniques used for children ( actually we have a whole department dedicated to this) so don't need any advice in this area:)Griplok info;http://www.zefon.com/medical/GRIP-LOK-CS-Securement-Device-for-Arrow-CVC-and-PICC-Hubs-p-1006.htmlPlease not that this product info shows a cooperative adult patient and/or application of the griplok under anaesthetic conditions. My issue is taking the griplok OFF and putting on a new one on a wriggling, upset child with the griplok placed less than 0.5 cm from insertion point. Thanks in advance for your help

Could you please tell me what infusion conference this was as I would love to read some presentations. I'm a Paeds nurse in Australia working primarily in Oncolgy and also have many questions surround the use of heparin for locking central lines whole minimsing the risk of infection and maintaining patency specifically in the paed population, and if a safer alternative has been found. I'm aware that there are clinical trials investigating the use of heparin, although I think the results were inconclusive.

How stressful for you. What happens if a child needs intubating, that is who is responsible for stabilising a critically ill child before transfer to a facility that can better look after sick children?Who prescribes IV medication if there are no doctors available eg a 2 year old presents with probable meningitis needs IV antibiotics ASAP? There are so many scary scenarios, and to have to deal with this on your own with limited experience is unacceptable.I'm a paed nurse in Australia and unless I was a nurse practitioner or working in a remote setting ( ie the nearest major hospital was like 500km away) I have the right to say that this job is beyond my scope of practice, and I would be taking this to the executive level as well as the Unions. At a practical level, if an ill child was to present to your hospital while you are on nights, and you had any doubt in caring safely for them, I would be organizing to have them transferred to the closest major hospital that have the resources to care for them ASAP. I really hope you get some support where you work soon :)

I agree 100% with all these comments , and just wanted to add that even in home health care nursing (Paeds) we would never give out our personal phone number and would be counseled and disciplined if we did. This type of emotional over-involvement has no place in delivering professional, competent and compassionate nursing care to children and their families.