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daylily
Cat Scan usage of power PICCs (are they really being used?)

I am curious if any of you have surveyed your cat scan department to see how many powered devices are actually used.  I recently had our CT department RNs record one months usage and it was incredibly low.  Believe me they love these devices and would not use a PIV due to the risk of extravasation! 

Our physicians have been asked if they want to make the decision regarding what kind of PICCs we place and they said no.  We use a valved product (non-powered) and a powered product.  If a patient is going home on abx. therapy we most often choose non-powered.  If we can insert the valved with not having more than a couple of centimeters external and patient diagnosis doesn't indicate CT will do so, otherwise we insert the powered device.  Seems like oncology patients and patients with bowel disease are the ones requiring CT.  But, now that I see they aren't being utilized like we anticipated it seems like a waste of money.

What kind of criteria do you use to place a powered PICC?  Have you checked to see what the usage is?

momdogz
Power is the only type of

Power is the only type of PICC we place for all patients - inpatient, discharge with PICC patients, and outpatients.

I don't have specific stats about usage, but they are used a lot for CT, and are regularly ordered because the MD knows that a patient will be needing serial CT exams.  

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Chris Cavanaugh
Since the status of

Since the status of inpatients in an acute setting can change at anytime, I advocate for the use of a power/pressure injectable device for all patients.  You never know when a patient could have a change in LOC resulting in a need for a head CT.  It is much safer and less invasive, less painful for the patient to be able to use the device he has instead of being stuck again for an IV for a contrast injection.

If the power injection in a capability of the PICC and the power injectable PICC does not place the patient at any higher risk (not all Power injectable PICCs fall into this catagory) I see no reason not to use a power injectable PICC on all inpatients.

I don't agree that Power injection is needed in other settings, such as homecare, long term care, outpatients, where the probability of CT is very, very low.

Chris Cavanaugh, CRNI

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Gwen Irwin
We tried to use non-power

We tried to use non-power injectable PICCs and power injectable PICCs. based on the patient's condition and current condition.  We evaluated the current situation and tried to make a decision based on that.  In reality, we discovered that patient's condition change.  Who has the crystal ball? 

Let's see..........hmmmm..........do patient's conditions change?  Yes, the conditions do change.  We had patient's with non-power injection PICCs that had a condition change that needed a power injection for CT.

After a few of them had condition changes and had to have an exchange to a Power PICC in Special Procedures, we decided to insert only power-injectable PICCs.  Due to the additional expense of a special procedure to do an exchange before the CT, the number that had to go through this we decided as the Venous Team to only place power-injectable PICCs.

Gwen Irwin

Austin, Texas

momdogz
The power injectable PICCs

The power injectable PICCs we use are very safe to send patients home with, so there is no reason for us to include "power injectable or not power injectable" criteria in our decision making process.

And - as Gwen points out - things change.  If there is no clinical reason not to use a Power PICC, why not give the patient a quality, safe catheter that can be used for more indications if needed?

Another issue - standardization.  It may be easier to teach and maintain education with smaller facilities, but it is a real challenge to use several different types of vascular access devices in one facility, and make sure all the staff know how to use them safely.  

Our facility - MDs, RNs, Quality, Risk Management, Value Analysis, Administration....worked very hard together to choose the absolute maximum number of devices, now have very few different types, and only 2-3 vendors.  Not only is it saving the hospital money, it adds patient safety in that the staff will be much more familiar with the limited number of devices that they are required to know about.

Our department (excluding me) and our Interventional Radiology department chose one brand and one type of power injectable PICC.  The MDs chose one (possibly 2) type of non-tunneled non-dialysis central line, dialysis chose theirs...etc.

Makes my job teaching MDs and RNs a little bit easier and clearer.  

We do a thorough prePICCplacement evaluation and will talk the docs out of a PICC line if we don't think the patient needs one, but if the patient does need a PICC, understanding the chemical and mechanical trauma that power injection of contrast through a peripheral IV causes to the tunica intima/media of a vein, even saving the patient ONE of those events by placing a power picc vs non-power picc could be a big benefit.  

 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Vera Deacon
We, along with the
We, along with the Interventional Radiiologists decided to stay with our valved product (which we have been using for quite a few years) and not to transition to a power device, the main reson being the increased cost associated with these products. We are a hospital of over 1000 beds, Level I trauma/burn center, etc..and have been able to function quite well without power injectable PICCs. It's easier on the staff as well not to have various products to add to their confusion. We do have patients admitted to this facility from other facilities with power PICCs in place and CT will not power inject through these devices because they have not been placed at our facility and the staff is not familiar with the variety of these devices.
lanstan
One of the reasons we don't

One of the reasons we don't use them is because there seems to be conflicting info about what to flush with. I have read saline followed by heparin but some patients have come from other hospitals  and say they were taught saline only.

 When a patient goes home with a PICC and it needs heparin it can be more difficult for the patients.

What do you all flush with?

lynncrni
The power injection feature

The power injection feature does not dictate the type, volume, concentration or frequency of catheter flushing. If the catheter has a valve, follow the manufacturers instructions for flushing. If it does not have a valve, flushing depends on what needleless connector you have attached to it. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

daylily
With acute care

With acute care facilities cutting staff positions, withholding raises, eliminating conference reimbursement (to name a few) I am looking at product use and subsequent cost.  Certainly manufacturers of these power products want us to feel that we shouldn't be using anything but.  However, when they are NOT being used it doesn't justify the additional cost. 

I was just curious if others have asked their CT department to capture usage.  It sounds like they haven't 

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Catheters that are power injectable are not much more in cost than non power these days.  One would be hard pressed to find a triple lumen PICC line today that is non power injectable.  It is also becoming more difficult to find a PICC that is not power injectable at this point.  The following companies all offer power injection at this point.  angiodynamics, Arrow, Cook, Bard, Jet Medical, MedComp, Navilyst, and the soon to be Vasonova is coming out the gate power injectable.  I am not sure why we are having this discussion as in two years I don't think a catheter will be on the market that is not power injectable.  In fact the new Chinese PICC is even power injectable. To my knowledge the cost differential in a basic kit is about $8 - $10.  Now if one is comparing a full barrier kit with power to a basic kit with no power than the cost difference is alot larger as the kit has more supplies.  Compae apples to apples and look at cost diifferences. Compare products.  Look at national agreements.

Kathy 

 

Kathy Kokotis

Bard Access Systems

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