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Shirley Ellis
catheter selection choices
Does anyone have a decision tree style form that addresses catheter selection of PICC:  single, dual, triple, power vs nonpower picc placements.
that they would be willing to share with group or private?  

I believe the catheter selection should be the clinician choice, based on:  review of chart, diagnosis, medication (s), length of treatment and presentation of veins (or lack of) at the time of insertion.  Comments? 

Does any facility have where the physician must specify the PICC:  type, lumen, etc??? before the nurse can place the PICC?

Shirley Ellis
Gwen Irwin
Check the downloads there is

Check the downloads there is one decision tree.


Shirley Ellis
Gwen, I have reviewed those,
I have reviewed those, which are more of a vascular access type.
I am looking for PICC choice only (no ports, tunneled,etc).
When / Why someone would put in a single lumen instead of a dual lumen, or the reverse why a dual instead of a single.
Why a power vs non power, etc.
We don't have anything

We don't have anything formal as far as decision trees or the like--generally inserter's prerogative. Sometimes the ordering MD will specify a type of PICC--if I don't think it's the right one,we talk first.

As for why a particular device,you're right about it coming from a chart review,anticipation of needs,etc but that's a rather imprecise "science" and I have guessed wrong more than once on that "anticipated needs" part.

I have to choose from: 4FR Midline,4Fr single Groshong,5Fr Dual Groshong,5Fr Dual Power PICC and 6Fr Triple Lumen PP.  

For outpatient use: 4Fr Midline if treatment anticipated to be very short term,like a week or two of antibiotics or hospice care. 4Fr SL for the vast majority of those going home with IV access needs--works fine for ABX,chemo for CA,IVF's for hyperemesis,etc. I rarely place a dual lumen for home use unless the patient will be getting two ABX's,one of which will probably be on a 24-hr pump and the other a bolus or IVPB.

For inpatients: 4fr Midlines are rare for me (4% of total in 2006) but they do have their place. A lot of the Midlines for patients that I have been called to do a PIV for--if I have to use US to find a vein,I might as well go the extra few steps and give them a reliable midline for a few days. Sometimes there is an issue with the central veins that precludes central PICC. Some recent examples and diagnoses---migraine+no veins,laboring mom + no veins,abdominal pain with stenosed subclavians,endocarditis with a new AICD. 4Fr SL's have their place,too---simple cases of infections,routine post-op needs,pneumonia,etc---longer-term needs than a ML,more frequent blood  draws,Vanco,Rocephin,IV KCL for meds but little possibility of compatibilty issues cropping up.

Dual and triple are the vast majority of my inpatient placements. The TL's are great in the ICU's--3 lumens solves a lot of compatability issues,they are CT-injectable and CVP transduceable. The decision for Groshong vs PP for the dual lumens for me is diagnosis-dependent. If there seems to be any likelihood of a CT during the patient's stay,I'll use the PP's. We haven't consistently had the DL PP's in stock,but when we have them,I use them frequently (last Monday,for example:1 TL PP,3 DL PP's,2 5Fr Groshong,1 4Fr Groshong).

I just got word that Bard's power-injectable Groshong is now available. It's a 5Fr silicone catheter with a 17ga lumen and 4ml/sec rating. I anticipate that this will take the place of a lot of the 4Fr Groshong's that I place,especially those patients who will likely need CT's as outpatients (abscesses,CA) in addition to their IV medications.

My 2-cents worth,anyway. Regards.

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