I have looked over INS Standards, INS Policies and Procedures, ande the Infusion Nursing textbook. I can not find anything at all about avoiding BP monitoring on the side of the PICC. I understand the rationale given by Lynn Hadaway (See previous topic on BP's on PICC arms) but does anyone have any document that recommends this practice. When I first received training on PICC lines (1998), I was taught that BP's, blood draws and IV's should be avoided on the PICC arm.
I do see the statement to avoid the IV in the arm but nothing on BP monitoring. Did I make it up? Oh dear.
Chris Thomas
No, you did not make this up. This has been part of every PICC insertion course I have taught since I started doing it in 1991. In the INS textbook, see page 464, "BP reading should be taken on an extremity that does not have a venous access device.". This is in the chapter on peripheral devices, but I do believe it applies to PICCs in several ways. Arm compression could initiate contact between the vein wall and catheter thus beginning the clotting process. It could also compress the catheter, just like the muscle pump action, and cause the expulsion of any locking solution and draw blood back into the catheter lumen which would clot. I have included this in several of my articles. I am curious as to why this has become such a big deal in your facility. Is this an academic discussion or has there been some problem or patient complication that raised this issue? Do you frequently see patients that would not allow a BP in either upper extremity, say one with a graft or fistula and one with a PICC? If there is concern over BP in the same extremeity as a graft or fistula, where is their evidence for this policy? I think it all comes down to the same thing - precaustions to prevent thrombus. Also, have you looked at the manufacturers instructions for use for the PICCs you are using? What do they say about this in their care recommendations? Have you contacted the PICC manufacturer? Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
As I have always known about not taking BP's, I am continually badgered by the Big Institution that want evidence on everything. You have given me the resources to send back to them but Oh, My is this getting rediculous or what?
I actually had to give them evidence on why we wear masks for changing central line dressings and why we need Chloraprep instead of alcohol to start an IV. Do you think I am being used? I know you have.
Chris
Looks like your Big House has adapted EBP in a big way, maybe too big!! Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Is it appropriate to use forearm or check BP below picc?
Absolutely, I though about that a few days ago, but forgot to add it to my message. Thanks for adding it. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861