When placing a PICC on a hospitalized patient, do you remove the peripheral? Do others simply send the patient back to the room with the peripheral and the PICC?
I have been thinking that I should try to change the process, so that I would d/c the peripheral and discard any IV solution prior to sending the patient back up to the floor.
This would eliminate the possibility that the nurse just changes the IV tubing from the peripheral to the PICC. I'm not sure why I am thinking this way as we have a near 0 infection rate. Wondering what the process is at other hospitals?
I only remove the peripheral if it is non-functioning, or if the patient complains that it is painful. If the PIV is functioning then I don't remove it until the CXR is read, and then only if I'm still hanging around the unit - I've done dressing change rounds days after PICC placement and noted the same PIV is still in place, having never been removed by the bedside nurses. Sigh.
Khadijah Smith RN
Clear Lake Regional Hospital
I only remove the peripheral if it is non-functioning, or if the patient complains that it is painful. If the PIV is functioning then I don't remove it until the CXR is read, and then only if I'm still hanging around the unit - I've done dressing change rounds days after PICC placement and noted the same PIV is still in place, having never been removed by the bedside nurses. Sigh.
Khadijah Smith RN
Clear Lake Regional Hospital
In my opinion, a complete process would include removal of any previous catheter the patient had and set up of new tubing and fluids through the new catheter. I would not leave this portion of the process for someone else to do. What would happen if that PIV was forgotten and no one removed it, then it produced purulent thrombophlebitis, requiring vein removal and lengthy antibotics? You could continue this scenario to have the edema from the thrombophlebitis produce nerve damage that leads to complex regional pain syndrome and a lawsuit. Both the primary care nurse and the infusion/VA nurse would be named. So I would complete the process and remove the old catheter. Lynn
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
I don't routinely remove PIVs after PICC is placed. It requires amount of time for the PICC line to be confirmed by chest x-ray to use. And also, there are patients we have will still need the access besides the PICC we placed. Removing the PIV by PICC RN who may not be quite familiar with patient's treatment plan is not always the best for the patient. I always remind the nurse though before I leave the floor to remove the PIV if it is not needed after the x-ray confirmation of the PICC.
Since we insert and do CVC maintenance on all PICCs we do an initial catheter dressing check and flush at the 48hr mark and likewise on any patients transferred out of ICU--Over the past 10 years have found many interesting peripheral IV scenerios in play long after the catheter has been released for use--Expired PIVs in use instead of the PICC and infiltrated PIVs below the PICC--We have made it our policy to remove ALL PIVs (Occ in ICU an additional IV is required but the policy states it must be in the opposite arm)--We also have in the policy that all infusion systems must be discarded and replaced with new bag and tubing (Occ if a critical fluid was recently hung we ask the clinician to just replace the tubing)
Robbin George RN VA-BC
Robbin George RN VA-BC