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emergency picc?

I recently had an ER physician request an emergency picc line on a patient that was sent to ER with a suspected pulmonary embolus and was symptomatic. He told me to "throw one in" so that she could have a lung scan done asap. I explained to him the time I would need and that the patient required a quicker access at this point but I would insert one later. I did insert a 20g in her hand for the scan, but the ER physician was livid. He told me that I had to follow his orders no matter what. I will be bringing this issue to administration. Does anyone have anything in writing or any guidelines that could help?I don't have a problem inserting the line, my problem was the lady was in distess and he thought that I could throw one in as if I were doing an IV line in the hand. Any help would be appreciated.

You were correct. The idea of

You were correct. The idea of "just throw one in" is absolutely not acceptable under any circumstances as there are other more appropriate means. I am not aware of anything published on this issue. I would be the first one to say that PICCs may need to be inserted under urgent circumstances and that patient needs must be the guiding force for the practice, not nursing work hours or convenience of the inserters. But in this situation, you did not have a diagnosis and therefore did not really know if a PICC was truly indicated or not. A PICC was not required for her to get the scan and the short peripheral catheter worked well. I would have followed up on the final diagnosis to learn what that was and make the appropriate point with this doc based on the outcome. If the scan was positive, that still may not mean that a PICC was indicated. You are an autonomous professional responsible for your own practice. You are not there to only follow his orders  no matter what. You may need some solid practice guidelines about the indications for a PICC and when and where they will be inserted and under what circumstances. This would remove the PICC inserter from a situation such as this with nurse vs doctor. Just my opinion, Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Karen Day
Karen Day's picture
I feel your pain, I have had

I feel your pain, I have had many physicians and nurses ask me to "throw a picc in" for them, I think it is very disrepectful to our profession.  I have not, however, had a physician ever go the the extent that this one did with you.  It is our responsibility to determine the best access for our patients and with our expertise, we can often achieve a PIV that others can not.  I have had some very similar instances where a patient was in need of a lung scan to r/o a PE and no PIV access could be achieved so a picc line was requested.  In these scenarios, I too would look first for an appropriate access site peripherally.    Since this exam requires power injection of contrast, our facility requires access in a larger vein preferrably near or around the AC fossa and will not use sites in the wrist or hand.  There have been numerous times where I was able to achieve a PIV for this exam and all including the MD, but most of all the patient were grateful; however, i have had to put in an occassional picc line for this exam as none of our other central lines are capable of handling the power injection. 

Robbin George
Looking forward to the Power

Looking forward to the Power Wand coming to market--Great bridge IV

Robbin George RN VA-BC

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