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jibles23
Can two central line exist at the same time?

Is there any known rule or policy from the INS with regards to placing a PICC with a patient who has a

1. pacemaker

2. exisiting upper body central line (e.g. Quinton cath, Trialysis, Port-a-cath.)

I would appreciate any answer thank you!

lynncrni
No professional organization

No professional organization writes rules or policies. There are voluntary standards or guidelines 

There is nothing that prohibits placing a PICC with any other CVAD or pacemaker. Many times both are needed. For a pacemaker, insert from the opposite side. Consult with your cardilogist about the age of the pacemaker and their professional opinion about the presence of any CVAD. 

For HD catheters there is often the need for any infusion catheter with the HD catheter. 

For an implanted port, evaluate the patients VA needs to see if the port can be used instead of another CVAD. 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

jibles23
as always thank you Ms. Lynn

as always thank you Ms. Lynn for your expert response, Ive encountered a scenario where the doctors are suspecting a port a cath(right upper chest) to be the source of infection. patient now on septic shock when brought in the hospital and on pressors, requested for vat team to place a PICC, how would you handle this situation? as our hospital policy states that pt that is suspected of sepsis is not a candidate for a picc insertion. 

also, is it okay for a picc to be placed if the port a cath is infected?

lynncrni
First and foremost, the

First and foremost, the patient must have some type of VAD to infuse pressors. Since pressors are vesicants by continuous infusion, a CVAD is the most appropriate, but a PICC is not the most appropriate in critical care and oncology patients. These patients are at high risk for vein thrombosis and thrombosis rates with PICCs are also high. Your original question only asked about 2 lines simultaneously and that is frequently done. To determine if any is the cause of a BSI, you need to draw 2 sets of blood cultures - one from the peripheral vein and one from the CVAD at the same time. If time to positivity or colony count indicates the catheter is the cause, it should be removed. In any patient  that is septic you don't have the luxury of waiting for culture results. If the CVAD is suspected in a patient  with septic shock it should be removed immediately. The most appropriate type of CVAD would be a low IJ insertion of a CICC, not a PICC. 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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