Janine Pritchett, RN-BC, BSN, VA-BC
Clinical Educator - Vascular Access
At our hospital the Picc nurses are having a discussion concerning the correct placement of the tip of the Picc catheter. Could we have some feedback as to whether it should be in the lower SVC/cavioatrial. Or is is ok to leave it in the Right atrium?
mamirhekmat R.N. C.R.N.I.
Does anybody know if sodium hydroxide is sold already compounded? Our pharmacy will not compound it so that we may dissolve lipid deposits in our PICC lines. We are unable to use ethanol due to our PICCs being polyurethane.
Ethyl Alcohol disolves lipid and lipid based poducts.
You might want to try this.
None of the alternative catheter locking solutions have been cleared for market by the US FDA. There is plenty of published research on a wide variety of solutions such as ethanol, sodium citrate, EDTA, and taurolidine. There are many companies trying to obtain this FDA clearance with these solutions in prefilled syringes, but none are available yet. So to obtain these solutions, you will need to contact a compounding pharmacy in your area. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
what amount of TPA do you use for 3 fr piccs? do you go by pt's wt i.e >30kg or <30 kg?
anyone with a protocol for exchanging piccs? can you exchange after picc has been in for over 24 hours and now it's malpositioned? please share thoughts! thanks !
We use .5mg/.5ml tPA for catheter clearance in the 3 Fr PICC and most all of our other lines. Weight comes up constantly around here because of the way the P&P was written by the pharmacy. I tell the staff that you are treating the catheter not the patient and the internal volume of the lines is very low, so seldom is more than .5mg required unless it is in a second instillation because the first was unsuccessful. While it is possible for some tPA to be instilled into the circulation the dose is low and the half life is short. I alsways recommend using the smallest possible dose regardless of weight, otherwise, for some of our larger patients the staff would be using 2 mg unnecessarily. If the catheter clears with .2 or .3 then there is no reason to give more.
Angela Lee, CRNI
Childrens Health Systems
I second the use of the BD pediatric/neonatal manual for vein diagrams. I took the course YEARS ago, but still use the lovely diagrams!