Definitely not! I have a legal case now where an out-of-control diabetic had a dual lumen placed when the therapy did not require a dual lumen and he end up with a serious vein thrombosis. If the therapy does not require multiple lumens, you should not place them. You have the catheter diameter issues and more lumens increase the risk of CRBSI. Of course this increased risk should not deter you from placing a dual lumen if the therapy demands it because multiple insertion procedures and sites also carry their own risk. Lynn
please tell me what are the indications for a 4fr vs a 5 fr? the folks ordering the piccs think 5 is better than 4 and 2 lumens are better than 1? i would liketo see a flow chart to allow proper determination of which size to use for the indication.
This requires an assessment by a knowledgeable infusion nurse specialist. If there are drugs ordered that are incompatible with each other, 2 lumens are needed. If you have continuous infusions of heparin, TPN, aminophyllilne, vasopressors, etc plus other infusions and/or intermittent meds, a dual lumen is needed. But for only intermittent meds with no other infusions, a dual lumen is not needed. I have a legal case now where the inappropriate use of a dual lumen is a major part of my testimony. 2 antibiotics were the only IV therapy this patient required, so no need for a dual lumen. The standard of practice is that the smallest size catheter be used - always has been to minimize the vein trauma and the space taken by the catheter inside the vein lumen. Lynn
thanks lynn, i am in an outpatient clinic setting with ultrasound. we will be doing non-critical patients ( as opposed to a hosp. critical care setting)
am i right in assuming that we will be doing mostly 4 fr single lumen or do outpatients/ nursing hom pts. have multiple drugs issues?
Smallest number of lumens for ordered therapies, smallest diameter of catheter possible is always the way to go. You must think ahead, but for homecare patients a single lumen is much simpler to manage unless you have a continuous infusion with multiple therapies. For TPN we always place a double lumen though. I am not sure the exact rationale for this other than labdraws, because TPN with or without lipids could be infused through a single, if that's all the patient is on. Many hospitals like to designate a lumen just for TPN.
Pat, the smaller the catheter, the better for the vein it sits in. I used to place 3 French singles prior to ultrasound technology with minimal complications with blood draws and occlusions. It's all in the care and maintenance of the catheter. I knew pediatric ICU nurses who could keep a 2 french patent with no problem. They knew how hard an i.v line was to come by. It's okay to use a 4 French single when intermittent antibiotics are given. Like others have said, it's the continuous infusions that may require a double lumen.
The bigger the better frame of mind should not describe piccs, it's the education for care and maintenance that's needs to be driven home. I've seen many 6 french triples in ICU patients that did not maintain patency due to poor care, not to mention swollen arms from the larger catheter use.
Patrick,one thing to be aware of is that not all SL will be 4fr and DL 5Fr. You can see a SL in anywhere from a 2Fr-5Fr and a DL in a 4Fr-6Fr. So, if you don't think its a good thing to step up in size but feel the patient would benefit from a DL, such catheters are available out there.
Are there guidelines to help justify a single when a double is requested by the doctor (ie. if the patient is in the hospital and on 2 or more antibiotics?) Do certain antibiotics like vanc. require an additional lumen for blood draws? Most hemoc patients and ICU patient seem to require a double lumen and usually CT compatible. Is this justifible? Thanks. Greg
I don't think there are guidelines that will dictate this. It requires the assessment of the infusion nurse or PICC nurse.
We try to evaluate the patients' actual need. For multiple antibiotics that are not incompatible is one thing (rare), but if staggering the delivery time allows the use of a single lumen, that is what we put in. We find that some of the ICU or the intermediate care areas want more lumens than are necessary. This also occurs with the oncology nurses. We explain that the fewest lumens are in the best interest of the patient, based on CDC guidelines. They are getting more comfortable with this. Our network is really trying to decrease the number of CRBSI's. We feel that our assessment supports the decrease of lumens and therefore decrease the CRBSIs. The nurses also respond to our effort.
This is a common question that often comes up when I teach a PICC class. I have always said that you should always think single lumen first and only give a dual lumen if the patient needs one>
There are of course lots of good reasons for a dual lumen. Anyone on TPN, heparin, pressors or multiple meds etc.
But consider all the PICCs we place for patients for patients going home on ABX. If they go home with a DL, they need twice the flushing supplies and additional teaching.
Also, based on the assumption that the bigger the PICC, the higher the risk of thrombosis, a 4fr single should be used.
Although nurses love lumens (the more the better some think) we should give the patient what they need. This is also a CDC guideline.
Don't forget, the single lumen of 4fr SL PICC is larger than either lumen of a 5fr DL.
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
please tell me what are the indications for a 4fr vs a 5 fr? the folks ordering the piccs think 5 is better than 4 and 2 lumens are better than 1? i would liketo see a flow chart to allow proper determination of which size to use for the indication.
thanks,
pat
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
Lisa Y., Team Leader IV Team UPMC St. Margaret Pittsburgh
Has anyone ever seen a"fatty" substance in blood drawn from a PICC line??? The floor nurses say it looked like chicken fat-I did not visualize it.
Any idea as to what this could be?
Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy
thanks lynn, i am in an outpatient clinic setting with ultrasound. we will be doing non-critical patients ( as opposed to a hosp. critical care setting)
am i right in assuming that we will be doing mostly 4 fr single lumen or do outpatients/ nursing hom pts. have multiple drugs issues?
thanks,
pat
Hallene E Utter, RN, BSN Intravenous Care, INC
Pat, the smaller the catheter, the better for the vein it sits in. I used to place 3 French singles prior to ultrasound technology with minimal complications with blood draws and occlusions. It's all in the care and maintenance of the catheter. I knew pediatric ICU nurses who could keep a 2 french patent with no problem. They knew how hard an i.v line was to come by. It's okay to use a 4 French single when intermittent antibiotics are given. Like others have said, it's the continuous infusions that may require a double lumen.
The bigger the better frame of mind should not describe piccs, it's the education for care and maintenance that's needs to be driven home. I've seen many 6 french triples in ICU patients that did not maintain patency due to poor care, not to mention swollen arms from the larger catheter use.
Laura McRae, RN, BSN, CRNI
Are there guidelines to help justify a single when a double is requested by the doctor (ie. if the patient is in the hospital and on 2 or more antibiotics?) Do certain antibiotics like vanc. require an additional lumen for blood draws? Most hemoc patients and ICU patient seem to require a double lumen and usually CT compatible. Is this justifible? Thanks. Greg
I don't think there are guidelines that will dictate this. It requires the assessment of the infusion nurse or PICC nurse.
We try to evaluate the patients' actual need. For multiple antibiotics that are not incompatible is one thing (rare), but if staggering the delivery time allows the use of a single lumen, that is what we put in. We find that some of the ICU or the intermediate care areas want more lumens than are necessary. This also occurs with the oncology nurses. We explain that the fewest lumens are in the best interest of the patient, based on CDC guidelines. They are getting more comfortable with this. Our network is really trying to decrease the number of CRBSI's. We feel that our assessment supports the decrease of lumens and therefore decrease the CRBSIs. The nurses also respond to our effort.
Gwen Irwin
Austin, Texas
This is a common question that often comes up when I teach a PICC class. I have always said that you should always think single lumen first and only give a dual lumen if the patient needs one>
There are of course lots of good reasons for a dual lumen. Anyone on TPN, heparin, pressors or multiple meds etc.
But consider all the PICCs we place for patients for patients going home on ABX. If they go home with a DL, they need twice the flushing supplies and additional teaching.
Also, based on the assumption that the bigger the PICC, the higher the risk of thrombosis, a 4fr single should be used.
Although nurses love lumens (the more the better some think) we should give the patient what they need. This is also a CDC guideline.
Don't forget, the single lumen of 4fr SL PICC is larger than either lumen of a 5fr DL.