I hope your PICC does not reach the IVC, so it cannot interact with the filter at all.
Is the patient at higher risk for thrombois, and that is why you are asking? Yes, he will be at higher risk and this risk must be explained to the patient and the ordering MD, and risks vs benefits to the patient need to be considered.
We need to stop looking for absolutes in medicine and use our critical thinking skills. Patients are not absolutes. There is no black and white. Specialists and experts in the field of vascular access (which we are) use critiical thinking skillss to evaluate each situation for the best outcome for the patient. It is when we get to that level that we will be recognized as the specialty we are and not "just a nursing team"
I couldn't agree with you more, medicine is not an absolute. I came to the forum for feedback because a former co-worker state it is contraindicated to place PICCs in pt's with filters. I understand this pt population is prone to clots and needed more info from the experts. Thanx
Chris I have to take issue with your comment about "not just a nursing team". I firmly believe that an infusion team is the correct organizational structure for such specialist. Being part of such a team implies the speciality knowledge and skill in much greater force that being a nurse employed in some other capacity. Infusion teams are needed critically in all hospitals to address all issues involving vascular access and infusion therapy. Lynn
I believe you misunderstood my comment, and I am not sure that this is an appropriate forum to debate or discuss personal issues. Your reply does nothing to address the question posted.
My comment referrs to the fact that today, in many facilities, the nursing team that places catheters (call it whatever you like, VAD team, VAT, Infusion team, IV team) gets little respect from MDs and administration because they do not perform as experts and professionals, rather they blindly follow orders as written.
Critical judgement is needed, and these teams should be given consults and the ablitiy to make decisions for what is the best line for the patient at that time. That was my point. It is only by changing policy to reflect this practice and acting as experts in making recommendations and providing the best option based on the needs of the patient will they earn the respect they deserve.
I would appreciate it if in the future, if you have an issue with something I post, please email me directly rather than debate in this forum. Thanks.
Chris, I have been an extremely strong proponent of infusion teams for more than 40 years and will continue to work diligently to get these teams recognized and reinstated in hospitals. Any comments such as yours placed in a public forum will be addressed in a public forum and I don't see a problem with that approach. Disagreeing with other professional colleagues is totally acceptable, in my opinion.
In my experience, I have found that nurses organized in a centralized infusion team, take a more professional approach to their work and are recognized by all other professionals for their contribution. These teams use a standardized approach so that outcomes can be appropriately measured. These team nurses are more committed to lifelong learning in their specialty. I definitely do not find this to be the same when nurses from any other job description (house supervisors, critical care nurses, PRN pool nurses, etc) are assigned the task of 'PICC insertion". I totally agree that critical judgment is required and I also find that more readily when nurses are working on a team rather than as an individual in a decentralized approach. Nurses on a team take infusion therapy and vascular access more seriously as a speciality. In fact, I found this to be so bad, that many years ago when I was still teaching PICC courses, I would refuse to teach a class at a hospital that took such as decentralized approach. After I gave a PICC course for the third time at one hospital like this, I said never again. Lynn
Pat, to address your original question, a PICC or any other type of CVAD is not contraindicated in a patient with a Greenfield filter. These filters are placed in the inferior vena cava and a CVAD (which includes PICCs) have the tip residing in the superior vena cava. The only time it could be an issue is when the CVAD is placed from the femoral vein or some other location such as transthoracic or transhepatic veins. Lynn
Hi, I am not sure what the issue is here, but I want to thank you all for #hashing it out. I was able to move from a PICC team to a VAT team by consults. We place PICC, USG-PIV and soon midlines, CVC, ART,etc. after reviewing the need and dicussion with the physcian. They now say" just ask the VAT" when there is an issue or need. I would not known to make this shift or how to accomplish it unless I kept up with the comments here. I am in a rural health hospital and there is no one here but me that can do what I do. Please keep the comments and disagreements coming. I can learn from all of them. I can now considered the vascular access expert at my hospital and I owe a debt of gratitude to all of the experts on this forum. It helps to know both sides when I am arguing with a physcian since I don't have a backup. Sorry to dump on the thread.
I have not commented before and may have sent a partial reply.
For clarity purposes, I understand the question was a Greenfield IVC filter, there is a patient population that have SVC (superior vena cava) filters. This is not a common treatment modality and on history it may have been documented only as a vena cava filter or not included in a patient's history. A PICC insertion on this patient with a SVC filter is contraindicated. Your own assessment of the CXR is valuable in these type of circumstances.
Findings such as these may be overlooked by other specialties and enhance our value as vascular access teams or infusion teams.
Glen Leif, RN
Vascular Access Team
Duke University Hospital
You are absolutely correct. I was only thinking of an IVC filter and and and SVC placement for a filter. They are probably rare but are seen. Thanks, Lynn
Why are you asking this question?
I hope your PICC does not reach the IVC, so it cannot interact with the filter at all.
Is the patient at higher risk for thrombois, and that is why you are asking? Yes, he will be at higher risk and this risk must be explained to the patient and the ordering MD, and risks vs benefits to the patient need to be considered.
We need to stop looking for absolutes in medicine and use our critical thinking skills. Patients are not absolutes. There is no black and white. Specialists and experts in the field of vascular access (which we are) use critiical thinking skillss to evaluate each situation for the best outcome for the patient. It is when we get to that level that we will be recognized as the specialty we are and not "just a nursing team"
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
I couldn't agree with you more, medicine is not an absolute. I came to the forum for feedback because a former co-worker state it is contraindicated to place PICCs in pt's with filters. I understand this pt population is prone to clots and needed more info from the experts. Thanx
PBarney RN CRNI OCN
Chris I have to take issue with your comment about "not just a nursing team". I firmly believe that an infusion team is the correct organizational structure for such specialist. Being part of such a team implies the speciality knowledge and skill in much greater force that being a nurse employed in some other capacity. Infusion teams are needed critically in all hospitals to address all issues involving vascular access and infusion therapy. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I believe you misunderstood my comment, and I am not sure that this is an appropriate forum to debate or discuss personal issues. Your reply does nothing to address the question posted.
My comment referrs to the fact that today, in many facilities, the nursing team that places catheters (call it whatever you like, VAD team, VAT, Infusion team, IV team) gets little respect from MDs and administration because they do not perform as experts and professionals, rather they blindly follow orders as written.
Critical judgement is needed, and these teams should be given consults and the ablitiy to make decisions for what is the best line for the patient at that time. That was my point. It is only by changing policy to reflect this practice and acting as experts in making recommendations and providing the best option based on the needs of the patient will they earn the respect they deserve.
I would appreciate it if in the future, if you have an issue with something I post, please email me directly rather than debate in this forum. Thanks.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Chris, I have been an extremely strong proponent of infusion teams for more than 40 years and will continue to work diligently to get these teams recognized and reinstated in hospitals. Any comments such as yours placed in a public forum will be addressed in a public forum and I don't see a problem with that approach. Disagreeing with other professional colleagues is totally acceptable, in my opinion.
In my experience, I have found that nurses organized in a centralized infusion team, take a more professional approach to their work and are recognized by all other professionals for their contribution. These teams use a standardized approach so that outcomes can be appropriately measured. These team nurses are more committed to lifelong learning in their specialty. I definitely do not find this to be the same when nurses from any other job description (house supervisors, critical care nurses, PRN pool nurses, etc) are assigned the task of 'PICC insertion". I totally agree that critical judgment is required and I also find that more readily when nurses are working on a team rather than as an individual in a decentralized approach. Nurses on a team take infusion therapy and vascular access more seriously as a speciality. In fact, I found this to be so bad, that many years ago when I was still teaching PICC courses, I would refuse to teach a class at a hospital that took such as decentralized approach. After I gave a PICC course for the third time at one hospital like this, I said never again. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Pat, to address your original question, a PICC or any other type of CVAD is not contraindicated in a patient with a Greenfield filter. These filters are placed in the inferior vena cava and a CVAD (which includes PICCs) have the tip residing in the superior vena cava. The only time it could be an issue is when the CVAD is placed from the femoral vein or some other location such as transthoracic or transhepatic veins. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi, I am not sure what the issue is here, but I want to thank you all for #hashing it out. I was able to move from a PICC team to a VAT team by consults. We place PICC, USG-PIV and soon midlines, CVC, ART,etc. after reviewing the need and dicussion with the physcian. They now say" just ask the VAT" when there is an issue or need. I would not known to make this shift or how to accomplish it unless I kept up with the comments here. I am in a rural health hospital and there is no one here but me that can do what I do. Please keep the comments and disagreements coming. I can learn from all of them. I can now considered the vascular access expert at my hospital and I owe a debt of gratitude to all of the experts on this forum. It helps to know both sides when I am arguing with a physcian since I don't have a backup. Sorry to dump on the thread.
I have not commented before and may have sent a partial reply.
For clarity purposes, I understand the question was a Greenfield IVC filter, there is a patient population that have SVC (superior vena cava) filters. This is not a common treatment modality and on history it may have been documented only as a vena cava filter or not included in a patient's history. A PICC insertion on this patient with a SVC filter is contraindicated. Your own assessment of the CXR is valuable in these type of circumstances.
Findings such as these may be overlooked by other specialties and enhance our value as vascular access teams or infusion teams.
Glen Leif, RN
Vascular Access Team
Duke University Hospital
You are absolutely correct. I was only thinking of an IVC filter and and and SVC placement for a filter. They are probably rare but are seen. Thanks, Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861