Forum topic

We are an independent company and we frequently get calls to place PICCs in the ER.  One hospital in particular has guidelines that state that the patient can't be sent to the floor without IV access.  What I usually find when I am called there is a patient with absolutely no access who needs to be admitted for several weeks of therapy.  We see alot of patients with a history of drug abuse with no access in the ER, also.  The ER nurses are great and they have usually attempted  to place a PIV.  Since we have a 4 hour response time, we are not usually called for ER patients who are crashing or need IV access within the hour in order to receive treatment.  As far as an ideal place for sterile procedures, I find the ERs to be one of the cleanest places around, with lots of room for setup!

We don't generally place PICC's in the ER as a rule.  The ER nurses are excellent PIV starters.  When they do call us, it's because the patient is truly an access challenge, or has a history of needing PICC's and will be an admission.  This doesn't always need to be done in the ER and can sometimes wait until the pt. is admitted, but sometimes the ER needs lab work or would like to begin IV therapy.  In an emergent case, the PICC line is not expected.  And as far as cleanliness, I have never considered the ER any less clean than the units.

Like any request for a PICC, you have to evaluate the entire situation:   the patient, their total IV therapy needs, need to access right now, and in the ED, the setting.   In some hospitals, the ED may have a quiet procedural area that will allow you to do it.