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clhunchusky
Early assessment of potential PICC patients on admit
We are in the process of trying to implement an early assessment program on admission for potential PICC candidates (versus waiting till their veins are all buggerd up!)  We now have IT sending us a list daily of the new patient admits, along with their diagnosis, etc.  We are attempting to be pro-active but don't want to appear like we are PICC chasing? Hope that makes since?? How are those of you out there that do early assessment handling this? Thanks in advance. Cindy Hunchusky, RN/Harris Methodist Hospital/Forth Worth, Texas/PICC TEAM
Linda C Motley
We get an admission list

We get an admission list with diagnosis, age, etc. from IT and a list of persons started on targeted drugs from Pharmacy.

LM

gretchen
My director and I were

My director and I were discussing this very thing yesterday!  I've been given an order for a PICC on an infant who has been poked 50+ times too many times recently!  I will be calling and getting a census printout and encouraging being PROactive instead of reactive! 

I have tried to encourage PROactive PICC orders, by going and asking the Doctor teams if they will have any orders for me today, and ask about specific patients as well. 

momdogz
Mari Cordes, BS RN  Nurse
Mari Cordes, BS RN 
Nurse Educator IV Therapy
Fletcher Allen Health Care

We use the admission data, and our IV team is very assertive about dialoguing with staff RN's and MDs on a daily basis re: specific cases.  We also have the good fortune of having state legislation that requires daily documentation of line necessity - and the IV team has been identified as the folks most appropriate to assess this.  It will bring us into daily dialogue/field of vision with the MD's - "vascular access rounds".

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Stephen Harris
Ask your clinical pharmacist
Ask your clinical pharmacist to provide you with a daily report on all patients receiving irritants and vesicants. You can select from that list as a starting point. If your risk management department can provide you with any information on monies they paid out for extravasations that can also be a strong impetus for early assessment and placement. Good Luck!
Kristin Walker
I'm wondering if Linda
I'm wondering if Linda Motley or anyone else can give me a list of drugs they use to have pharmacy flag for them?

Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.

momdogz
What kind of catheters do

What kind of catheters do you use?  Bard has great early assessment packages that have drug lists with them.  You can give these to MDs, RNs, pharmacy...the list is not all inclusive, but it's a good start.

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Linda C Motley
Here is the list Pharmacy

Here is the list Pharmacy alerts us about

Target Drug List for Central Line Access 

Medications that are irritants, vesicants, have a pH of <5 or > 9 or and Osmolarity >500 mOm

10% Dextrose (D10W)505 mOm
3% Sodium Chloridehypertonic
Acyclovir (Zovirax)pH 10.5 – 11.6
Amiodarone Hydrochloride(Cordarone)PH 4.08Mfg recommends dedicated line
Amphotericin B (Fungizone/Abelcet)irritant
Ampicillin (Unasyn)pH 8 – 10irritant
Calcium Chloridevesicant
Calcium Gluconatevesicant
Ciprofloxacin (Cipro)pH 3.3 – 4.6
Dobutamine (Dobutrex)pH 2.5 vasopressor
Dopamine (Inotropin)pH 2.5vasopressor vesicant
Doxycycline (Vibramycin)pH 1.8 – 3.3
EpinephrineVasopressor, vesicant
Erythromycinirritant
Gancyclovir (Cytovene)pH 9 – 11
Gentamycin (Garamycin)pH 3 – 3.5
NafcillinpH 10, hypertonicvesicant
Norepinephrine (Levophed)Vasopressor, vesicant
Penicillin GpH 8 – 10irritant
Piperacillin/Tazobactam (Zosyn)vesicant
Potassium Chloride(minibags)pH 4hypertonic
Sodium Bicarbonateirritant
Sulfamethoxazole/Trimethaprim(Bactrim)pH 10
Tobramycin (Nebcin)pH 3 – 6.5
TPN/PPNhypertonichyperosmolar (600 – 1300 mOm)
Vancomycin (Vancocin)pH 2.5
donlussi
Pen G info?

Hi, I was just curious, where did you get your information for Penicillin G.  The sources I'm reading do not tell me it's an irratant and states a lower ph?

Donna Lussier

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