I am employed by a HCA facility and they are responding toÂ a sentinel event with a new protocol for preventing air embolism.Â Â Never Events Air embolism.
They are requiring this process be implimented Hospital wide and to include picc lines.Â IÂ have been doing picc lines for about 3 years now.( small hospital 100 beds average 0-5 piccs a day).I have reviewed the recent INS standard book out.Â I am not yet a member of INS of AVA so IÂ have not been able to examine much on their website.
They are requiring head of bed down 15-20 degrees for insertion. I know the rationale of this for a central line inserted in the subclavian or juglar but not inserted peripherally.Â Are any of you doing this in your facility?Â Do you think or is their evidence to support this position for PICC lines inserted in the arm?
I will just state the steps I have not utilized in the past.
they want the patient placed in trendelenburg, and after removing the dressing they want sterile technique and Â the site to be cleansed with chlorhexidine. , pt for perform the Valsalva maneuver during catheter removal.Â After removal of line and removal of gauze to put on antiseptic ointmentÂ ( vaseline gauze is recommended in their protocol)Â then opsite do another valsalva while changing gauze to vaseline.Â Another is to then have patient remain supine for a minimum of 60 minutes.Â Maintain occlusive dressing for 72 hours postÂ PICC Â removal.
I have done many searches and have found that the insertion site for the picc line of basilic vein, brachial etc...reduces the risk of air embolism but does not eliminate.Â I also understand the whole fibrin sheath and change in pressure to cause the air embolism.Â I am just wondering are any of you doing all of the above for a picc line removal?Â
As I mentioned I have read the INS standards and it is not as specific as what HCA seems to be requiring of us.Â
Thanks youÂ Â in advance for your responses!Â Gina Ward R.N., C.P.A.N.Â