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early assessment

When assessing patients on admit using INS guidelines for PH and Osmolarity, if a patient is placed on a vesicant or irritant do you automatically place a PICC line?  Do you wait for cultures or put in a picc line?   How does the early assessment program work?  Thank you in advance.

Amy

Robbin George
I like this question and
I like this question and hope there are many detailed responses--PICC teams seem to struggle with the best method to capture appropriate patients in a timely manner   

Robbin George RN VA-BC

lynncrni
The approach in my classes

The approach in my classes is to educate all primary care staff nurses about when a short peripheral catheter is no longer the best catheter for a patient. This would involve drug pH and osmolarity, length of therapy, condition of veins, number of attempts, condition of skin, etc. Once these primary care nurses identify the patients that need some other type of catheter, this triggers a consultation with the IV Team to do an indepth assessment to make the recommendation about the most appropriate catheter. We are a long way from getting this message into the main assessment processes of primary care nurses though. 

 The other approach is to create a list of medications and a list of diagnoses. Admission prints a daily report of patients with those diagnoses and pharmacy prints a list of patients on those medications. This list is what the IV nurse used to determine which patients need their indepth assessment. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Janine Pritchett
We have been using early
We have been using early assessment for several years at our adult hospital (Tacoma WA).  We have a daily census as well as a report from pharmacy (every 8 hours) with patients that are on medications that we have identified and then we can go and check out those patients.  We try to see every new admit within 24 hours as well.  (some days that works and some it doesn't!).  We now have the majority of calls from the nursing staff stating "we have a patient that needs a PICC".  So, don't loose heart, it will happen and the floor staff will learn from the IV team which patients need to have central access. 

Janine Pritchett, RN-BC, BSN, VA-BC
Clinical Educator - Vascular Access

Kevin Travis Flint
Do you have an assessment
Rhonda Wojtas
We are having the same

We are having the same issues trying to start early assessment. Our PICC team is only 3 months old. At this point in time all PICC line orders are still being booked thru IR. We call them every morning and check for new orders. The number of PICCs we do right now vary so much. One week we placed 17 PICC lines, 5  in one day. The next week we didn't do any 2 days and only did 3 the next 2 days. I have been gone the past week so not sure what has happened since.

We are starting to inservice the staff and doctors that we are here and available to do the PICC lines. Also that in many cases able to do them at the bedside on critical patients. We have been in a catch 22. Couldn't really be too assertive because we had not all finish our training. We could seek more PICCs than we could insert because they would fall back on IR and they don't want to do them.

It is my hope that now we are all trained and should be able to cover 5 days a weeks we will get more constistant orders. We do have some early assessment tools that Bard has given us that are like a post it note you place on the chart to indicat to the doctor that we have assessed the patient and why we think the patient will benifit from a PICC. I am hoping to start using them soon. 

I also personally spoke, what we are doing, with the pharmacist to let them know we are around and ask them to work with us  to help us identify some of the meds odered on new admit that should have PICC lines. They are very willing to help and provide and information to help as assess patients earlier.

I do assess the census daily and look at possible canidates by diagnosis. I also do and informal rounding on the floors to see if they have idenified any potential PICC patients. I am hoping that we can now start doing formal screening on the floors in the morning to better assess patients and be more proactive rather than reactive.

Rhonda Wojtas, RN VA-BC

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