Would like to hear what others are doing/would recommend for repositioning of a single lumen PICC placed too deep (immediately after post-insertion CXR). Would you cut the catheter & replace the leg/hub so as to prevent a longer external length (rationale: the less external catheter, the smaller the risk of migration) or leave the catheter intact with a longer external length (i.e., 10cm)Â (rationale: catheter integrity remains intact, thereby reducing the risk of crbsi)? Thanks in advance for any replies.
Forum topic
Wed, 11/14/2007 - 10:43
#1
Repositioning a single lumen PICC
We don't use Groshong catheters, so we don't have the option of cutting the external catheter, therefore we do have a longer external length. We have not experienced any risk of increased CRBSI with this practice.
Gwen Irwin
Austin, Texas
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
If the catheter needs to come out more the 3cm, we exchange to a shorter one.
Kathy Kokotis
Bard Access Systems
Most pull back anecdotally. Re-x-ray after pull back. It depends on how deep and how much left out in order to exchange.
As far as radiology gets revenue on PICC line insertions they do not. There is no reimbursement for a PICC line done in IR even by a doctor for the hospital that is. PICC lines should never be placed in an IR setting if it can be avoided as it is a high cost to the healthcare system. Patients are primarily based on "DRGs" today for reimbursement so there is no reimbursement for any central line placed on an in-patient including a port. PICC LINES do not belong in the IR I suggest looking at your facility payer mix.
Kathy Kokotis
Bard Access Systems
I would like to know what others are charging for picc exchange. If I do a picc exchange at time of insertion say for a too short of catheter, do I charge my regular picc insertion charge? do I add a picc exchange charge? If I do a picc exchange a couple days later, do I charge a picc exchange? If I'm unable to thread the catheter all the way, I make a referral to radiology & they do a picc exchange & they have a separate charge for picc exchange. Should I be using the same picc exchange charge as our radiology dept?
Thanks,
Dawn
Use of ECG guidance during placement would avoid the need for chest x-ray altogether. As I've posted on other threads, there is close to 100% correlation between ECG guidance and echocardiographic tip location (see http://www.pacerview.com/index_files/ECG_GUIDANCE_FOR_CVC_PLACEMENT_IN_THE_LITERATURE.htm) while there is only 80% correlation between chest x-ray (our current "gold standard" !) and echocardiography (and only about 60% between surface landmarks and echo). It's faster (saves 30-60 minutes / procedure since there's no waiting for an x-ray), less expensive (about $21.00 total per procedure), works with any open ended catheter with a non-insulated guide wire from any manufacturer and gives immediate feedback so you can leave the bedside knowing you are in proper position.