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Rob Burr
Evolving Vascular Access Role

The Intensivist at my facility has recently decided that PICCs have too great a risk of thrombus formation to be our first choice Central Line. This occured after a week in which 2 patients developed clots around their PICCs, both 6 Fr, and both multisystem failure long term patients. Overall, our thrombus rate is about 3%.

If it is true that the PICC is more problamatic than jugular CVC's we should indeed be providing the better service. The problem is that the intensivist is not good at placing lines. It would seem logical that Vascular Access nurses should evolve into the role of providing Vascular access of sorts other than PICCs. We certainly possess the skills to expand our role, and having more options would better serve our patients.

Are any of you placing jugular lines? The AVA supports IJ PICC placement, while the INS supports EJ placement, both under limited conditions and situations. What bewilders me is why we can place a PICC catheter but not a standard CVC... what really is the difference? Is anyone seeing an evolution of roles occuring?

There is some evidence that

There is some evidence that PICCs may not be the preferred choice for surgical patients. The following is a systematic literature review on the issue that found ~40% of PICCs failed prematurely in the surgical population.

 Turcotte S, Dube S, Beauchamp G. Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward. World J Surg. Aug 2006;30(8):1605-1619.

RE nurses inserting other types of CVCs, this is being done in some locations. The first thing you need to know is the method used by your state board of nursing on scope of practice decisions. Some states use a decision tree model while others use a declaratory ruling and a few still use advisory opinions. This method will provide direction on what you need to do to begin placing IJ or even subclavian inserted catheters. I do believe that nursing specialist should expand into these areas as well. We faced these same issues in the late 1970's and through the 1980's as PICC insertion become an acceptable practice for nurses. 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

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