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Jamie Sharp
Help with Protocols

I'm trying to find some articles or studies on 2 different items for our hosptial's protocols.  Does anyone know if there is a standard out there for repositioning lines?  If I've placed a line and the xray shows a malposition, I want to be able to go back to the room and repostion it.  Sometimes I'm lucky and just with a brisk flush I can fix the problem, but other times it would be a need to pull back and reposition it.  I've heard teams tell me their practice states they can repo a line if it's been less than 24 hours.  Any one have answers? 

Also, I've read an article from Stanford, that states they don't put in triple lumens unless the vien size is at least .5cm.  Are there any other articles besides that one, and what are other hospitals doing?

Thank you, 

Jamie Sharp, PICC Coordinator, IMC, SLC, Utah

lynncrni
Both issues have not been

Both issues have not been addressed in the form of a standard or guideline from any recognized professional body. Repositioning to achieve the correct tip location ***must*** be done before the catheter is used. So I do not understand the idea of being able to reposition within 24 hours. I have repositioned many PICCs but it was always during the initial insertion procedure and never later. 

There is a growing idea that no catheter should consume more than 50% of the vein diameter. This is based on the idea of increasing outer diameter of the catheter leads to a greater amount of endothelial damage and subsequent vein thrombosis. Until we began using ultrasound, there was no way to measure the vein's internal diameter.  Again, written standards and guidelines have not addressed this but it is a common practice among nurses who place PICCs. Lynn

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Jamie Sharp
Thank you for your quick

Thank you for your quick response. 

 In our institution, the line cannot be used until the PICC Team calls the bedside RN and tells them the PICC is central and ok to use, so, to go back to the room and repo after the PICC nurse looks at the Xray would always be before use of the PICC. 

We have never repositioned a PICC more than just a few hours after it was placed, but if I could have found a paper stating standard practice could go up to a 24 hour window, then we could wait overnight to see if the line would drop into place, and if it didn't, go back and repo it within 24 hours.

Again, thank you,  Jamie

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