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Laura Cook CRNI
PICC insertions in the ER

Do teams out there do PICC line insertions in the ER on a routine basis?  I think that that for sterility reasons that we should try to avoid this.  There is also an MD that is there to put in temporary lines on a 24 hour basis.  I also think that it would hold up the pt transfers to the assigned room.  What is everyones thoughts on this?  We have had several consults for PICC's in the ER recently......and not enough man power to cover them.  But I really don't think we should go there for many different reasons.

Thoughts?

lvhugrn
We also put them on the back
We also put them on the back burner because; a MD is on duty for CVC placement, sterility, lack of space, and the chaos that is part of ER.  On occasion however, if there is a valid need and other cases less in need, we insert in ER.
fentanylius
Early Picc assessment in the

Early Picc assessment in the ER is important. Why placing a Central Line for 24 hours if the patient get a Picc next day? At first it is not in the best interest for the patient, second it is waste of money, third, there is no reimbursement by placing a CVD by a ER MD during a Emergency treatment.

I place in our ER frequently Picc's, yes there is less space but I am able to do my sterile procedure. I have a overall infection rate from 0.14 % and I place around 60-70 Picc's a month.

Andre Schotte

RCRMC

Chris Naylor
It seems like they are
It seems like they are calling more and more frequently as they want power injection for CT. We do them in an area we can maintain sterility and insist that we are not going to do them emergently. If they can't wait for us, they need to put in something else.
lisayrn
We do get a lot of PICC

We do get a lot of PICC orders from our ED.  Some are very inappropriate and some are valid.  Our major barrier to serving the "appropriate" population is man power.  With the volume of inpt. and scheduled outpt. PICCs we do not have the staff and equipment(ultrasound) to get to the ED. 

If we can not get to the ED they seem to mysteriously not need a PICC anymore.  Our team puts the ED population on the back burner if you will.  They have qualified staff to insert lines if it is a true "emergency".  A PICC is not a line to be placed as an emergent intervention.

Hopefully you have support from managment, our clinical coordinator is also responsible for the ED so she understands both sides.

Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy

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