Do anesthesiologists at your facility use PICCs for induction and throughout surgery? Ours won't. They seem to think that they can't give fluids/meds fast enough via a PICC.
Ours are unlikely to use PICCs. We use smaller PICCs in our (pediatric) population anyway so anesthesia will place a PIV for their uses during surgery.
I have encountered lots of resistance to PICCs from anesthesiologists. This is due to the slower flow rates and this is a result of the catheter length. Length adds resistance. So the flow rate through an 18 gauge short PIV is much faster than through a PICC of the equivalent French size. I have seen the times when I used every trick in the book to get packed RBCs to flow by gravity through a PICC and it was extremely slow. So they do have a valid point in some cases, maybe not in all. But how does the anesthesiologist know which cases may go bad and need huge amounts of fluid before the case starts? We all need a crystal ball for things like this.
At our facility, I find that when Anesthesiologists use our PICC lines for surgery, the line comes back clotted off. I have had a higher rate of cathflo use post surgical patients with PICC lines that were used during surgery.
I find that the Anesthesiologists do not use a pump and have IV fluids running to gravity. When the fluids are not running "wide open" the PICC seems to clot off somewhere between the OR and the RR.
I strongly discourage the use of PICC lines in surgery unless absolutely necessary and I try to inform the CRNA or anesthesiologist to run the picc wide open or place on pump.
Generally, Anesthesiologists find the PICC line infusion too slow for their needs and want to start their own PIV.
We too have had a big problem with clotted PICCs in patients returning from OR. What we discovered was that the patient went to surgery with IV fluids running via their PICC, the anesthesiologist started his own PIV or central line, disconnected the IV fluids from the PICC and attached them to the new IV. But no one took any responsiblity for hepariniziing the PICC. So now we have a policy that states that all PICCs are hep-locked PRIOR to going to surgery unless they are receiving something that is life-sustaining or would jeopardize the patient in any way by having it stopped. The nurse is to discuss this with the surgeon prior to sending the patient to OR.
I have encountered lots of resistance to PICCs from anesthesiologists. This is due to the slower flow rates and this is a result of the catheter length. Length adds resistance. So the flow rate through an 18 gauge short PIV is much faster than through a PICC of the equivalent French size. I have seen the times when I used every trick in the book to get packed RBCs to flow by gravity through a PICC and it was extremely slow. So they do have a valid point in some cases, maybe not in all. But how does the anesthesiologist know which cases may go bad and need huge amounts of fluid before the case starts? We all need a crystal ball for things like this.
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
At our facility, I find that when Anesthesiologists use our PICC lines for surgery, the line comes back clotted off. I have had a higher rate of cathflo use post surgical patients with PICC lines that were used during surgery.
I find that the Anesthesiologists do not use a pump and have IV fluids running to gravity. When the fluids are not running "wide open" the PICC seems to clot off somewhere between the OR and the RR.
I strongly discourage the use of PICC lines in surgery unless absolutely necessary and I try to inform the CRNA or anesthesiologist to run the picc wide open or place on pump.
Generally, Anesthesiologists find the PICC line infusion too slow for their needs and want to start their own PIV.
Lois Rajcan BSN, RN, CRNI
Chester County Hospital Vascular Access Team
We too have had a big problem with clotted PICCs in patients returning from OR. What we discovered was that the patient went to surgery with IV fluids running via their PICC, the anesthesiologist started his own PIV or central line, disconnected the IV fluids from the PICC and attached them to the new IV. But no one took any responsiblity for hepariniziing the PICC. So now we have a policy that states that all PICCs are hep-locked PRIOR to going to surgery unless they are receiving something that is life-sustaining or would jeopardize the patient in any way by having it stopped. The nurse is to discuss this with the surgeon prior to sending the patient to OR.
Wendy Erickson RN
Eau Claire WI