Lauretta

Feel free to e-mail me and I will be happy to answer any questions. FOr now I think the key is an aggressive assessment program I developed one and it has increased our PICC insertions.

The difference between a Groshong Central catheter and a standard central catheter is the Groshong Valve. This valve is incorporated on all of the Groshong catheters. The tip of the catheter is rounded and closed. When the catheter is not in use, the valve stays closed preventing the back flow of blood and air into the catheter. Negative pressure causes the valve to open inward allowing for blood withdrawal. When positive pressure enters the catheter either by gravity syringe or IV pump the valve opens outward allowing for the fluid to infuse. Because of the valve the company promotes the fact that anticoagulant flushes are not necessary. However, we maintain our heparin flush protocols and use only saline flushes on selected patients. As far as dwell time goes just because a catheter has a Groshong valve does not allow for a longer dwell time. There are other factors that effect dwell time such as the type of material the catheter is made of such as silicon vs polyurethane. Also the type of central line will also effect the dwell times. For instance a Triple lumen Catheter is a central line designed for acute care vs a peripherally inserted central catheter (PICC) which is also a central line which has a longer dwell time. You then have the subcutaneous chest and arm ports that are implanted central lines and don't forget the tunneled devices such as the Hickman catheter. The type of catheter that is chosen should fit the patient's needs but remember all central line placements have the tip of the catheter located in the Superior Vena Cava ( SVC). Ideally the tip locations should be at the distal SVC atrial junction. [This message has been edited by Lauretta (edited March 30, 2001).]

How about trying the Intravenous Nursing Society's web site. I think the web address is www.ins1.org If this is inocrrect just do a search. If the INS has their standards posted you should find eveything you need. Hope this helps!

We have been using the Modified Seldinger method of PICC insertion since January 2001. Prior to implementation, the State Board of nursing was consulted and then the procedure was presented to the Chief of Surgery who approved of this technique. This was then presented to the Medical Director who took this to the Medical Executive Committee and Clinical Practices Committee who gave the final approval. Our Medical Center is comprised of two divisions totaling 500 beds. The smaller division of 120 beds has five nurses certified in this technique three working both the IV department and the Medical Day Stay department. The larger of the two divisions have four full time IV nurses with an open part time position. I do not feel that all RN's should be permitted to insert PICC lines using a conventional method or the Modified Seldinger technique. There should be a limited number of RN's with excellent venous access skills selected to insert PICC lines.