Forum topic

 If there is a better way to communicate please share it.  It makes no sense to repeatedly put a patient through a procedure that has been unsuccessful for them.  Look at other options.

 The only true absolute contraindications for placing a PICC would include patients with compromised circulation on the proposed insertion extremiety (paralysis from any reason), need to preserve veins for future AV graft or fistula, and the need to reduce the risk of lymphedema following lymph node dissection. Also, orthopedic or neurological conditions with the proposed extremity would be a contraindication, along with a history of difficult or failed attempts. 

Increased risk of bleeding from any reason is not a contraindication for a PICC. In fact, in those patients, a PICC is the safest form of CVAD because you can apply direct pressure to the source of the bleeding. 

There are numerous contraindications for placing a centrally inserted CVC including respiratory issues, increased intracranial pressure, and spinal curvatures - all conditions that prohbit the Trandenlenberg position. 

I would not include Cf patients as contraindication for a PICC. 

I have never seen a list like you are asking for but what I have given you is what I previously taught in my PICC insertion classes. You would need to do a complete literature search to determine if evidence has revealed that anything else should be added to the list of contraindications. 

Also, we should not be thinking of a PICC as a strategy to reduce the risk of CLABSI. Evidence shows that the risk of BSI from a PICC is about equal to that of any other percutaneous CVAD. 

Lynn

 I apologize, I misread your question.  A list of "a type of" patients for a "do not picc" list I have not seen.  I have seen several facilities with repeat customers who have contraindications or previous failed attempts maintain lists.  These patients are typically referred to IR.  

We keep a database of all our picc lines, including ones referred to IR, using Microsoft Access program. Updated daily. Very easy to search the database by name, date, or pt ID number. Each entry has a spot for comments where we can write anything pertinent to the insertions, such as: "no problems", "difficult to get tip to drop on Sherlock", "unable to thread picc past shoulder on RUE, but no problems threading via Left basilic", stuff like that.

We have many repeat customers, so to speak, so I almost always look people up in the database first, before I even look up their chart or assess them. It's so helpful to know if a patient has had previous insertions/attempts and how they went. Can save hours of futility.

We do have some patients that we know through previous attempts that it is a waste of time for us to even try to place a picc. They are instant referral patients and we identify them by putting an asterisk after their name in the database.  There are some patients whose vessels are so bad IR even has to balloon angioplasty the central circulation to get the picc to thread. There's no way we are going to thread these lines at the bedside and we shouldn't be expected to try if we already know how difficult it is from past experience.

I cannot overstate just how helpful it is keeping a database like this.

Sam

Welcome to vascular access services!  I wish you well in this field:-) I have specialized since 1989 and love IV therapy.

We keep a do-not-PICC list according to failed bedside attempts.  The patients are referred to IR and we follow up to see what trouble, if any, that IR had. Although not necessarily documented, length of fluroscopy time can provide insight into how easily it was placed in IR. 

We list the patients alphabetically in a locked Word document that can be accessed only by the PICC/vascular access team members from any computer within the hospital system. 

We keep a list like this also.  It has proven to be very helpful and prevents hours of wasted time and patient problems.  We also have that very small group that even IR cannot do successfully.  We try to be proactive and assist their physicians to order a different type of access device for them, such a a Hickman.

Genine Schwinge, ANP-BC, PNP

J T mather Memorial Hospital

Port Jefferson, NY 11777

 Arm circumference taken before insertion provides a baseline measurement that can be compared to the circumference if a problem develops. Routine measurement on a regular basis provides no benefit and is not an evidence-based practice, but the baseline could be of benefit. Lynn