what are the indications for a 4fr single lumen vs a 5 fr double lumen? is the difference just for theÂ blood drawing ability?
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
please tell me what are the indications for a 4fr vs a 5 fr? the folks ordering the piccs think 5 is better than 4 and 2 lumens are better than 1? i would liketo see a flow chart to allow proper determination of which size to use for the indication.
Lisa Y., Team Leader IV Team UPMC St. Margaret Pittsburgh
Has anyone ever seen a"fatty" substance in blood drawn from a PICC line??? The floor nurses say it looked like chicken fat-I did not visualize it.
Any idea as to what this could be?
Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy
thanks lynn, i am in an outpatient clinic setting with ultrasound. we will be doing non-critical patients ( as opposed to a hosp. critical care setting)
am i right in assuming that we will be doing mostly 4 fr single lumen or do outpatients/ nursing hom pts. have multiple drugs issues?
Hallene E Utter, RN, BSN Intravenous Care, INC
Pat, the smaller the catheter, the better for the vein it sits in. I used to place 3 French singles prior to ultrasound technology with minimal complications with blood draws and occlusions. It's all in the care and maintenance of the catheter. I knew pediatric ICU nurses who could keep a 2 french patent with no problem. They knew how hard an i.v line was to come by. It's okay to use a 4 French single when intermittent antibiotics are given. Like others have said, it's the continuous infusions that may require a double lumen.
The bigger the better frame of mind should not describe piccs, it's the education for care and maintenance that's needs to be driven home. I've seen many 6 french triples in ICU patients that did not maintain patency due to poor care, not to mention swollen arms from the larger catheter use.
Laura McRae, RN, BSN, CRNI
Are there guidelines to help justify a single when a double is requested by the doctor (ie. if the patient is in the hospital and on 2 or more antibiotics?) Do certain antibiotics like vanc. require an additional lumen for blood draws? Most hemoc patients and ICU patient seem to require a double lumen and usually CT compatible. Is this justifible? Thanks. Greg
I don't think there are guidelines that will dictate this. It requires the assessment of the infusion nurse or PICC nurse.
We try to evaluate the patients' actual need. For multiple antibiotics that are not incompatible is one thing (rare), but if staggering the delivery time allows the use of a single lumen, that is what we put in. We find that some of the ICU or the intermediate care areas want more lumens than are necessary. This also occurs with the oncology nurses. We explain that the fewest lumens are in the best interest of the patient, based on CDC guidelines. They are getting more comfortable with this. Our network is really trying to decrease the number of CRBSI's. We feel that our assessment supports the decrease of lumens and therefore decrease the CRBSIs. The nurses also respond to our effort.
This is a common question that often comes up when I teach a PICC class. I have always said that you should always think single lumen first and only give a dual lumen if the patient needs one>There are of course lots of good reasons for a dual lumen. Anyone on TPN, heparin, pressors or multiple meds etc.
But consider all the PICCs we place for patients for patients going home on ABX. If they go home with a DL, they need twice the flushing supplies and additional teaching.
Also, based on the assumption that the bigger the PICC, the higher the risk of thrombosis, a 4fr single should be used.
Although nurses love lumens (the more the better some think) we should give the patient what they need. This is also a CDC guideline.
Don't forget, the single lumen of 4fr SL PICC is larger than either lumen of a 5fr DL.