i would like a copy of that also if you don't mind sharing. We have a new PICC team and are still trying to work through some of the bugs. Thanks! My email address is [email protected].
Are you talking about medical contrandications such as bilateral mastectomy or just reasons why bedside placement would be impractical ? Or maybe both. The only impractical reason would be that we can not get the patient to cooperate. They could be combative or abusive or spitting at us. We tend to send those down to IR so they can be medicated,and I am glad to comply!!!!
Can you please send me a copy of your policy for contraindication. I need to educate some staff and MD's on when a PICC is not the best choice and could use all the help out there. If anyone knows of specific articles please forward those also.
At the intitution I work at we have a policy on laboratory values that have to be met before PICC placement. They are: INR has to be less than 3, Platelets must be above 50, and PTT less than 80
I would think that these are the very patients where a PICC would be the safest type of vascular access. So rather than prohibit placing PICCs in these patients, I would prefer a PICC over using the IJ or subclavian veins.
Can you pls. suggest websites or articles/journals where I can obtain some information re: inserting bedside PICC's on patients with pacemaker( contraindications if there are any and complications of inserting PICC's on the same side where the pacemaker was inserted). I had browsed through google... there were only a few topics which did not give a lot of information about my inquiry. Thanks !
I had looked for this information a year or so ago and couldn't find much. I spoke with an IR physician that was active with AVA regarding hsi pratice. It made sense to me, thus the facility that I worked at adopted this practice. If the device was less than 30 days old, the PICC was not placed on that side, but if it was > 30 days, it was. The theory here was that the device leads were encapsulated in fibrin, thus decreasing the risk of the catheter device entwinment (is that a word?)
I agree with Lynn here. I do not have apolicy that sets parameters for not placing a PICC when coags are off. We feel those patients are sick and in need of reliable safe access as soon as possible and we feel the PICC is the safest route in those situations. We take extra precautions to decrease bleeding and bruising in these patients.
One should be careful with placing a PICC in the same arm where a Pacemaker or ICD has been implanted. Most subclavian veins have narrowed over time around the indwelling leads. This results in a higher degree of difficulty in passing the catheter through the vessel. Also, Midline placement may instill IV fluid into the device pocket. This may cause a device pocket infection. These wires or leads are stiff and fine and could cause shearing of a catheter with placement and/or removal.
This web site has an EXCELLENT video on it from Cheryl Kelley R.N, !!
It discusses many aspects of picc insertion. I must say this is the most informative piece of information I have found on PICC lines in the last 4 years.
I took 5 pages of notes on it ( front and back). It helped me develop a pre assessment tool prior to putting in lines ; starting with assessing the reason, the patient hx, choice of lines, precautions, contraindications, vein assessment etc. I cant brag enough on it!!
I went to the website and opened it up. It has some pop ups and as you try run the video and it does not run look at the bar on the top of your screen, it tells you to open up something or "allow" something to run to be able to watch the video.
Dava could I have a copy of your policy. My email is [email protected]
Rod D. Kunze RN, RCIS Action Site Manager, Door 2 Balloon coordinator PICC coordinator St Vincent Healthcare 1233 North 30th Billings, Montana 59101 Work (406) 237-4300 FAX (406) 237-4390 Beepe
our Policy states that in order to get a picc a pt has;
To be getting TPN for greater than 3 days-Must have nutrition consult that supports need for TPN
Ab Rx for >7 days
or complex Medical conditions
However... GFR must be >30 for PICC. If Gfr is low then a PICC may be placed by IR in IJ -- typically tunnelled subclavian cath --if other criteria met
MD must consent Patient
No Blood cultures drawn or must be neg for 48 hours before insertion
No lab draws from PICC unless lab is unsuccessful x's 2 people who try twice
4 french only is the choice cath unless TPN or Multiple incompatible meds.
I love it when there are anecdotal exclusion criteria
Suggest one does a research project of the literature before taking anecdotal commentary from this board on exclusions that may or may not be evidence based
This would make a great topic at a conference as to what are the real published exclusion criteria.
Dava'
I would like a copy of your policy also for contraindications.
My email is [email protected]
Thanks
Hi Dava,
Could you please give me your info regarding an indication/ contraindication policy as well? My email address is [email protected]
Your help is greatly appreciated.
Dava,
I would love a copy of your policy as well. My institution's policy does not include contraindications.
Thanks in advance,
-jenn
[email protected]
Dava-
Would you be willing to send your indication/contraindication policy to me?
[email protected]
Thanks.
Sally
Sally,
My policy is under review with the committees. When it is done I will be happy to send you a copy. Email me your request to [email protected]
Donna
Hello Dava,
I would really appreciate a copy of your indication/contraindication policy as well if you do not mind sharing.
Thank you so much! My e-mail is [email protected]
Dava,
Can I get a copy of your indication/contraindication policy? Email [email protected] Thanks.
Cindy Hunchusky, BSN, RN, CRNI
Hi Dava,
Could you please email your policy? I appreciate it. Thanks!!
Stacie Dorting
[email protected]
n
we are in the process of forming policies any help would be greatly appreciated
[email protected]
thanks
michael stevens
Hi Dava, May I please have policy of indications/Contraindications?
Also, some nurses I work with are concerned about infection control risk of inserting at bedside. Are there any journal articles on this topic?
Hi Dava,
May I please have a copy? My email is [email protected]
Thanks
Louise M
Thanks Dava,
My email is [email protected]
Dava,
Not sure if you sent the email with the policy or not. Just wanted to make sure my email didn't fail.
Thanks!
In our intitution I met with Infection Control, Renal Services, and Oncology services.
We do not insert a PICC if blood cx are positive and until we see at least 2 days of negative survalience blood cx.
Every patient with blood createnine greater the 2.0 must be approved by Renal service for PICC insertion.
We do not insert in Mastectomy with lymph disection on the affected side.
When it is end of life comfort care - we do a PICC where ever we can find a vein.
Dava,
Can you please send me a copy of your policy for contraindication. I need to educate some staff and MD's on when a PICC is not the best choice and could use all the help out there. If anyone knows of specific articles please forward those also.
Rose
[email protected]
Rose Galyan RN, BSN, CRNI
Speciality Practice Nurse
Vascular Access Team
Indiana University Hospital Bloomington
[email protected]
Asherwood,
Can you please send me a copy of your policy?
Thanks,
Rose
[email protected]
Rose Galyan RN, BSN, CRNI
Speciality Practice Nurse
Vascular Access Team
Indiana University Hospital Bloomington
[email protected]
I would think that these are the very patients where a PICC would be the safest type of vascular access. So rather than prohibit placing PICCs in these patients, I would prefer a PICC over using the IJ or subclavian veins.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Dava,
Would appreciate a copy of your policy as well. Thanks in advance
[email protected]
Cheryl Kelley RN BSN, VA-BC
I agree with Lynn here. I do not have apolicy that sets parameters for not placing a PICC when coags are off. We feel those patients are sick and in need of reliable safe access as soon as possible and we feel the PICC is the safest route in those situations. We take extra precautions to decrease bleeding and bruising in these patients.
Jose Delp RN BSN
Clinical Nurse Manager IV Team
Upper Chesapeake Health
Jose Delp RN BSN
CliClinical Nurse Manager IV Team
Upper Chesapeake Health
Cheryl,
One should be careful with placing a PICC in the same arm where a Pacemaker or ICD has been implanted. Most subclavian veins have narrowed over time around the indwelling leads. This results in a higher degree of difficulty in passing the catheter through the vessel. Also, Midline placement may instill IV fluid into the device pocket. This may cause a device pocket infection. These wires or leads are stiff and fine and could cause shearing of a catheter with placement and/or removal.
Paul Howell
Janet Erickson
Gina Ward R.N., C.P.A.N
www.firstdonoharm.com
This web site has an EXCELLENT video on it from Cheryl Kelley R.N, !!
It discusses many aspects of picc insertion. I must say this is the most informative piece of information I have found on PICC lines in the last 4 years.
I took 5 pages of notes on it ( front and back). It helped me develop a pre assessment tool prior to putting in lines ; starting with assessing the reason, the patient hx, choice of lines, precautions, contraindications, vein assessment etc. I cant brag enough on it!!
Hope this helps, Gina Ward R.N., CPAN
Gina Ward R.N., VA-BC
Hi Gina,
I can't get the video to work. do i need to join or click on something?
I went to the website and opened it up. It has some pop ups and as you try run the video and it does not run look at the bar on the top of your screen, it tells you to open up something or "allow" something to run to be able to watch the video.
hope it helps, Gina
Gina Ward R.N., VA-BC
Hi Dava,
Can I please have a copy of your indications/contraindications policy? Thank you so much! My email is [email protected]
Dava, can I also get a copy of your policy, my email is [email protected]
Thank you
Dolores Tinker CRNI
Hi Dava
Can also get a copy of your policy
Thank you
[email protected]
Dolores Tinker CRNI
Dava,
I'd like a copy of your policy as well.
Thanks,
Amy
Dava could I have a copy of your policy. My email is [email protected]
Rod D. Kunze RN, RCIS Action Site Manager, Door 2 Balloon coordinator PICC coordinator St Vincent Healthcare 1233 North 30th Billings, Montana 59101 Work (406) 237-4300 FAX (406) 237-4390 Beepe
Dava, May I please have a copy of your policy? We are a new PICC team. My email is: [email protected] Thank you so much!
Janet Eckard
I would appreciate a copy of your PICC exclusion policy thanks very much
Michael Stevens
St. Mary's Hospital Passaic NJ
[email protected]
our Policy states that in order to get a picc a pt has;
To be getting TPN for greater than 3 days-Must have nutrition consult that supports need for TPN
Ab Rx for >7 days
or complex Medical conditions
However... GFR must be >30 for PICC. If Gfr is low then a PICC may be placed by IR in IJ -- typically tunnelled subclavian cath --if other criteria met
MD must consent Patient
No Blood cultures drawn or must be neg for 48 hours before insertion
No lab draws from PICC unless lab is unsuccessful x's 2 people who try twice
4 french only is the choice cath unless TPN or Multiple incompatible meds.
I would appreciate a copy of picc exclusions.
thanks
dorothy bennett
bassett medical center
[email protected]
may i also have a copy.
thanks.
[email protected]
I love it when there are anecdotal exclusion criteria
Suggest one does a research project of the literature before taking anecdotal commentary from this board on exclusions that may or may not be evidence based
This would make a great topic at a conference as to what are the real published exclusion criteria.
kathy
Do RN picc inserters get paid as level 2 in Qld?
Hi Dava,
We are also updating our policy, I would love to see a copy of your policy.
Thanks,
Denise
DHarris
thanks!
David
Please send me A COPY AND IF YOU HAVE ANY SUPPORTING EVIDENCE BASED DOCUMENTATION TO SUPPORT IT
THANK YOU,
DIANE SUTER, RN
PICC/IV CLINICIAN
SAVAHCS, TUCSON
[email protected]
Diane Suter, RN, VAT
SAVAHCS
Might be easier to post in the "Resources" section.....Less headache to re-post each time!
Hi Dava, Could you please send me your policy also?
[email protected]
Thanks, Kim Mills
Best article:
Ryder, Marcia Nursing clinics of North America 1993 on PICC Options - still holds today. One of the best articles ever written on PICC lines
The article also has contraindications for subclavian and jugular access as well
See your manufacturer instructions for use as well
Kathy Kokotis RN BS MBA
Bard Access Systems
I would like to see your policy. You also might want to add to the resources section of this site. [email protected]
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