Forum topic

I work for a health system that owns 2 hospitals. I manage the PICC team at one hospital and I have a counter-part who manages the PICC team at the other hospital. Our nursing policies are universal between both facilities. We both serve on the Policies and Procedure Council together. Our policy has always been that any patient admitted from the community with a PICC line as a direct admit or through the ER must have a chest xray to verify line placement before the PICC line is to be used. We have standing pre-printed orders in place to back up our policy. These standing orders were approved by the board of physicians within our health system.  Last week a surgeon admitted a patient with a PICC line and refused to allow us to xray the patient for PICC tip verification and told the nursing staff that it was ok to use the line. I was tied up in an insertion at the time so the manager of the unit called my counter-part at the other hospital who said "If we are unable to obtain an xray of the PICC and there is good blood return then the PICC may be used as a peripheral IV."

I feel that if the PICC tip placement cannot be confirmed when the patient enters the hospital after being out in the community, then the PICC should not be used. My concern is that if not properly communicated and labeled as "Peripheral Access Only" a PICC line that is possibly malpositioned may be used for the delivery of vesicants or high risk therapy. 

I do not see anything in the INS standards that support using a PICC as a peripheral IV for any reason.  Is it acceptable to use a PICC line as a peripheral IV if the verification of PICC tip placement is not confirmed?

Cyndi Dautel R.N., CRNI