I am searching for any evidence-based practice literature that states that a PICC should not (or is not recommended) be placed in a non-mobile arm (stroke patients, paralysis, etc.). Our physicians are questioning this practice, and I cannot find any information specifically related to this topic. Lynn Hadaway........can you also provide any feedback? Thanks for any comments.
I have not done a literature search on this issue for at least 4 years so I am not certain if there is anything new. The basic reason is found in alteration in normal human anatomy and physiology. Non-mobile arms do not have the normal venous pump action, aka muscle pump action. This is described in all physiology textbooks and the chapter on A&P in the INS textbook. And do not allow this physician to tell you that alteration in normal A&P does not count as evidence!! 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
Thanks for the support, and the reassurance that we too feel is based on evidence of the anatomy & physiology of the vessel.
Cindy Hunchusky, BSN, RN, CRNI
I know that the INS and AVA do not recommend placement ipsilateral to injury or paralysis.
2011 INS Standards of Practice; Standard 33 Site Selection; III Central Venous Access via Peripherally Inserted Central Catheters (PICCs); C. Veins in an upper extremity should be avoided on theside of breast surgery with axillary node dissection, after radiation therapy to that side, or with lymphedema, or the affected extremity from a cerebrovascular accident.
For that section the INS cites
8. American Nephrology Nurses’ Association Board of Directors [position statement]. Vascular access for hemodialysis. http://www.annanurse.org/cgibin/WebObjects/ANNANurse.woa/wa/viewSections.... Published 2010. Accessed March 17, 2010.
9. Felty CL, Rooke TW. Lymphedema. In: Fahey V.Vascular Nursing. 4th ed. St Louis, MO: Saunders; 2004:33-46.
11. Institute of Medicine. Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
The AVA citation list is long...I can post it if you want?
Asystole RN, BSN, CRNI, VA-BC
Vascular Access Nurse, Infusion Nurse
That would be great! Thanks much.
Cindy Hunchusky, BSN, RN, CRNI