Forum topic

Ann Zonderman, BSN, JD, CRNI, LHRM

I also see many power piccs in LTC/ sub acute and wonder - if the patient is not a ct or MRI candidate post acute setting - should another line be considered for these settings.  Lines are in use more frequently in Acute care.  More frequent flushing goes along with the more often  the line is utilized.  LTC lines are often used for daily infusions and the staff must be cognizant that the lines still need flushing - usually q shift 8 or 12 hr intervals to ensure patency.  NS flush only may not be practical when lines are used less often.

 INS guides us to use the smallest catheter for the prescribed therapy.  I do not see that practice being followed in regard to PICC placements.  Is  A 6Fr dual power line  necessary for say 6 weeks Vanco to treat a MRSA infedtion?   

Those of you placing power piccs = please offer some insight as to your choice of size and lumens .

Thanks

Ann

We only use the 6fr triple lumen Power PICC in the acute care setting of our hospital. In order to reduce the risk of complications,we try to exchange these PICCS whe there is no longer a need for three lumens.We also use 5fr single lumen Power PICCS if the patient only needs single lumen access but is recieving many scans that require contrast. I do not believe that a 6fr Power PICC is nessesary for IV Vanco. We have many patients that do very well with a 4fr single lumen  for the duration of their IV Vanco therapy and all of their labs draws.

our picc team will place groshongs for patients who will continue IV therapy outside of the hospital...we are in close contact with our home care companies and understand their needs. However, I work in a level1 trauma center...99% of the patients need frequent contrast studies.... we get numerous requests for the power lines...they are helpful to the docs. ..we typically place a 5fr dual for hospital patients...single 4 fr for the home patient...

cathie 

    Pts should be assessed for the need for a power injectable line.  Those lines are usually higher in cost and require more time and maintenence then a whole lot of other lines.  We see about 80% more problems with the power injectable lines, then we do with our regular catheter (PASV).  We use a positive pressure cap on the power lines, and still see a very high percentage of occlusions with them, while only having one occlusion with our PASV last year.  The power lines are sceduled to be flused every 8 hours with 10 to 20cc NS.  We are a heparin free facility and like it that way, so we do not place these lines unless neccessary.  We do a full patient assessment before placicng ANY line, and there have been very few that we have made mistakes in assessment on, and they usually have a change in treatment when we do see it happen.  We are getting ready to trial the Bard Triple with the center power injectable lumen, and those will be placed the same way.  As needed by assessment. 

Heather 

 I think the solution to this is that we will have to find better solutions to caring for these lines in the home care setting.  These lines are frequently placed during the diagnostic workup phase.  Having no crystal ball, we often don't know for sure what therapy the patient will end up on, or whether home care will become an option. 

The superiority of power-injectable PICCs in the acute care setting are subtantial. We used to place Groshong PICCs in 100% of our patients.  Over the past two or three years, the advantages of the Power PICCS have won us over to the point that we now use Groshongs only very rarely.  In addition to the power injection capability, we can also monitor CVP pressures if the patient ends up in the ICU. 

Our experience with occlusions and other complications has been the same or fewer than we experienced using Groshong PICCs.  We use saline flushes and a neutral displacement valve.  The lines are certainly more robust.  I have had them pulled out by patients, but never pulled apart. 

Jerry Bartholomew RN, BSN, CRNI

VA Medical Center, Spokane, WA

 Correction:  Make that "We used to place Groshong PICCs in 100% of our patients who needed PICC lines". 

Jerry Bartholomew RN, BSN, CRNI

VA Medical Center, Spokane, WA

Chris,

  Email me privately.

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Thanks

We are placing 5 french double lumen groshongs on most patients.  If we get a consult in ICU, the patient will get a 6 french Triple lumen POWERPICC unless the vein is not big enough on ultrasound.  I have had very little problems with occlusion on either line.  We flush the POWERPICCs with 1 ml of Heparin 100u/ml every 12 hours. 

I am always surprised when I see comments such as those who say they see increased clotting when using one open-ended polyurethane PICC over any other open-ended PICC. Would not every one agree that if a line is flushed appropriately, it will stay patent? If a positive or neutral displacement cap is used according to the manufacturers guidelines, the lumens will stay patent? If the catheter has a built in valve, will it not clot if not flushed appropriately? What should the rep say about this? Can a rep be at the bedside to make sure the lumen is flushed after that blood draw? There is only so much they can do for us. At some point we have to all agree that care and maintenance is the real issue at times. This is real world, not just the company line. In the real world, patient's who are in the hospital, especially those who are in the initial diagnostic work-up phase, need CT scans and MRI's with contrast. As Jerry said, there is no crystal ball that will tell you for sure who's who but there is no denying the patient's do receive these exams. The choice is yours and you should always do what is right for the patient. The right line placed for the needs of the patient. There are PowerPICCs from 4 Fr single lumen all the way up to 6FR Triple. Contrast injectable, CVP monitoring, the variety of lumens, tip location system to go along with each. Choose the right one for your patient. Why should they have to have a PIV for a contrast injection that is put in at high pressures and flow rates when they already have a picc line? Does this make sense? Why would I choose a non-power injectable line over a power injectable picc if they are the same french size? The cost difference is less than if I have to go start an IV for the CT scan! If I need a PICC, I hope I get the right PICC for me and what I need at the time of insertion, and I know that I would insist on my family members getting the right PICC so that they will not need repeated sticks when they have needs for any type of infusion therapy that may come.