How do you determine to place 4 fr. or 5 fr. picc lines? In our facility, we place 5 Fr. as our standard at the bedside and in IR. I was recommended by Bard clinical specialist to look for the size of the vein before I place a 4 or 5 fr. picc line. But it is difficult to carry all the supplies with me. What is the best for the patients?
The smallest size catheter capable of delivering the required therapy is the standard of practice. I have seen legal cases where catheter size is an important issue. You must have the ability to choose the best size for your patient based on the diameter of the vein. This requires having access to all sizes, single and multiple lumen catheters and ultrasound to properly assess vein diameter.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
We do a complete assessment before placing any PICC. We look at the diagnosis,current therapies prescribed,frequency of blood sampling,any CT scans,current lab values. Then we assess at the bedside...scanning potential veins for their location,size,quality,proximity to nerves and arteries etc. In the acute care setting we lean towards the dual. We have found that one lumen is not enough on our complex patient poulation. We have a rehab unit and a SNF and on those patients with minimal therapies we will often place a SL. In our ICUs we generally place an open-ended Tl.as one lumen is usually used for CVP monitoring. We have lots of ICU patients with 2 PICCs as well.
Hi Lynn,Karren,Bnosal and Mary Ann,
Thank you for your responses and your expertise.
When I placed the 4 fr. piccs, it was easier to place the 5 fr. Moreover, it is better for the patients, the smaller the better!! That's good to know.
Thanks again,
Ann
I routinely place 3 Fr in most of my older patients. Infants and toddlers usually get a 1.9 or 2 Fr. Some critical care patients will get a 4 Fr DL. I periodically get comments from other practitioners and even sales reps about placing larger catheters and feel I have to justify my decision and, of course, I always do with that same statement " the smallest catheter that will deliver the therapy". But the fact that it comes up made me realize that not everyone is aware of or follows that standard. I also do a thorough assessment on each patient and these sizes get the job done. I don't understand putting a larger catheter in for the sake of putting a larger catheter in just "because it can be done".
Kathy Kokotis
Bard Access Systems
It really depends on your patient population. Angela quoted her is in a children's hospital so her needs will go to the 1.9, 2, 3, french sizes. You are a University hospital and your needs will go to the 5 F, 6 F and rarely the single lumen 4 F. If you have an ICU patient I cannot see the need for a 4 F dual lumen so why bother just put in a short term acute care MD line. If the catheter fills up more than 50% of the vein you than have to step back and see if an MD line is needed if the therapy warrants multiple lumens. I believe in using the lumens the patient needs and that means the patient may not need a PICC line. It is really about the patient therapy needs in meds, blood draws so match the lumens to the patient and not the type of catheter.
I do not believe in trading down number of lumens a patient needs due to vein size. I believe in than utilizng a different type of insertion method, site, catheter to meet the patients treatment needs.
To me it is not about using the smallest catheter it is using the right device, site, numer of lumens. The PICC may not be the right choice.
For many University patients a 4 French DL is useless in blood draws and medication delivery. I would if that is the only choice the vein would accommadate chose a sublcavian or jugular placed MD line. It is about the patient not the smallest gauge an RN can place in the vessels they are only allowed to utilize at this point.
Kathy Kokotis
Kathy Kokotis
Bard Access Systems