Is it advisable to place a Power PICC in a pt to be used as a midline? I am not sure if it was placed because a dual lumen was needed, or what the reason was. I would think it shouldn't be used for CT?Â
Was it cut to length for a midline or was the amount inserted equal to a midline portion in the vein with the remainder outside the vein? Either way, there are numerous issues with this practice. I would never do or recommend either method. I certainly would warn against using this midline for a CT as this would be an off-label use. Lynn
The person that did PICCs at my institution prior to me, told me of this practice. She cut the POWER PICC to be used as a mid-line. I contacted BARD clinical support, and of course they said if this is done, it would definitely be "off label" and if anything happened it would be bad for me. I have always had questions in my mind about this practice both pro and con. Wondering why Lynn said she would never do or recommend this practice? Is it strictly because it would be off label use?
I have a cardiologist that has an aversion to central lines placed either subclavian or IJ and frequently orders "mid-line" for his patients particularly those with pacemakers despite the fact that the pacemakers are not new placements and we use opposite side. My concern always is that I place it as a mid-line now, pt goes bad and people start using it for Dopamine and other drugs that should be central. We go round and round.
Here are my reasons - a PICC cut to a midline length will still be labeled as a PICC on the external hub; great potential for misuse with fluids or meds intended for central vein infusion going through a midline. The off label use leaves the nurse and facility totally liable for any complications and their ramifications - could be very bad news. Finally I just don't like cutting catheters - never have! We have had very little evidence about the jagged edges on cut catheters and now have the research done by Janet Pettit, in JAVA. This validates my concern but we still don't have clinical outcomes with this practice yet. And we don't live in a one-size-fits-all world. Cutting a PICC to a specific length to still be a properly positioned PICC is one thing but cutting a PICC to be a midline is a risk I would never accept and would never advise anyone to do. Lynn
I have been told by Bard that the Power Picc is trimmable to midline length. As far as injection I suppose there has been some question to off use and Bard said not because of the catheter not tolerating the injection but risk of infiltration. When injection in CT thru a short peripheral line needing to use an anticubital vein is a longer IV more stable than a 1 inch line. Especially if the patients veins run deep. Just a thought. Of course I was originally told by Bard no problem to inject thru midline length and have just recently learned of the possible off use label.
Always ask for and expect any information such as this from a manufacturer to be given to you in writing from the manufacturer. Do not simply accept what a sales rep may tell you without this written documentation. Sorry to all the sales people out there, but the good ones know of the ones that will say anything to get the sale. Lynn
Speaking from medical imaging standpoint and a nurse who deals with contrast infiltrates, I can absolutely, with no hesitation in my voice: do not power inject midlines, even though they are power injectable!!! Contrast has an osmolality of 650 or greater and is injected at 2-4ml/second with a power injector
. You really want to deal with extravasated contrast in the auxilla? Try explaining this one to the legal nurse consultant sitting across from you. You can't.
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
The person that did PICCs at my institution prior to me, told me of this practice. She cut the POWER PICC to be used as a mid-line. I contacted BARD clinical support, and of course they said if this is done, it would definitely be "off label" and if anything happened it would be bad for me. I have always had questions in my mind about this practice both pro and con. Wondering why Lynn said she would never do or recommend this practice? Is it strictly because it would be off label use?
I have a cardiologist that has an aversion to central lines placed either subclavian or IJ and frequently orders "mid-line" for his patients particularly those with pacemakers despite the fact that the pacemakers are not new placements and we use opposite side. My concern always is that I place it as a mid-line now, pt goes bad and people start using it for Dopamine and other drugs that should be central. We go round and round.
Definitely interested in what others think.......
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
Lynn,
I have been told by Bard that the Power Picc is trimmable to midline length. As far as injection I suppose there has been some question to off use and Bard said not because of the catheter not tolerating the injection but risk of infiltration. When injection in CT thru a short peripheral line needing to use an anticubital vein is a longer IV more stable than a 1 inch line. Especially if the patients veins run deep. Just a thought. Of course I was originally told by Bard no problem to inject thru midline length and have just recently learned of the possible off use label.
thanks lisa
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
Speaking from medical imaging standpoint and a nurse who deals with contrast infiltrates, I can absolutely, with no hesitation in my voice: do not power inject midlines, even though they are power injectable!!! Contrast has an osmolality of 650 or greater and is injected at 2-4ml/second with a power injector
. You really want to deal with extravasated contrast in the auxilla? Try explaining this one to the legal nurse consultant sitting across from you. You can't.