On page 29 of the AVA certificaton exam study guide under "Contraindications for a PICC" there is no mention of the patient with a pacemaker--Is there a position statement on this subject anywhere that could be useful when evaluating a patient for PICC placement--We are still unclear as to the standards that should be applied to patients with a New v Established Pacemaker as we have read conflicting statements on this subject--Thank You Â
Robbin George RN VA-BC
It is my opinion that there is no "standard" about pts with pacemakers. You will find the practice all over the board. It is different in each facility and patient. It depends on what the cardiologist who place the pacers wants us to do.
At our facility we have come to an agreement with our cardiologist. We do not use the side of the pacer if it is less than 6 weeks old. After that it is not our first choice since the pacer wires already obstruct some of the blood flow. We do use the side with the pacer at last resort.
There was a posterboard in the 2007 AVA Conference that talked about this issue. Her name Melann Chiu from MD Anderson in Texas. Their conclusion was that it is preferred that the PICC be placed opposite to the pacemaker. However, if the oppsite side is not possible, then it is safe for PICCs to be inserted in the ipsilateral side of the pacemaker.
For other CVCs (jugular and subclavian), ipsilateral to the pacemaker should be avoided.
For PICC placement, I would rather do real-time imaging when placing it on the same side as the pacemaker.
Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]