Purple Power PICC by Bard

coronapeng · Mar 13, 2006

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.

wacajrn · Mar 13, 2006

Thank you for your reply. It sounds like we will be putting in some purple PICCs.

PICC ACE · Mar 16, 2006

Power PICC's for ALL Chemo patients? That's much too general and simplistic. What do your Oncologists say? Not every chemo patient has frequent CT's and they don't all have limitted-term,frequent treatments. Some would be much better served with an implanted port rather than a PICC,for example.

Power PICC's are a nice idea but they aren't without their potential problems. They need to be Heparin locked,which means there is the possibilty of HITT. Plus since every time a catheter is accessed,there is the chance for introducing bacteria,and with frequent flushes there is the inherent increased risk for catheter-related infections. The risk for air embolism is pretty low but there is the risk of blood loss if the cathter isn't properly clamped and capped--it's like having a 20ga straw in the vascular system. Finally,their size is an issue--complication rates go up as catheter size goes up,so you need to weigh putting in the 5Fr PP versus a 4Fr 'normal' line.

As for placement,I haven't had any particular problems with getting PP's or Triple Lumens in the SVC. After I get the cath in to where it's about mid-clavicle level I pull out the stylet to make the cath floppy and follow the vein path 'downstream'. Since you have US,you might consider trying scanning the patient's jugular vein before and after placement--most of time you can see the line in the jugular if it is there,and if so you can do some readjustments before you get your CXR.

Good luck.

wacajrn · Mar 19, 2006

Thanks PICC ACE for your input. Your points are well received. I do ultrasound the IJ post insertion and pre-chest xray. It saves inconvience, time, and money for all.

PICC chic · Mar 20, 2006

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.