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Inappropriate PICC orders

Does anyone have a policy that speaks to what makes a patient a PICC candidate?  I understand that this will never be black and white, but we do get a good number of inappropriate orders.

How about a policy or document of some type that discusses choice selection for central line insertion?\

Thanks as always,


I agree, it is done on a
I agree, it is done on a case by case basis. One admission the pt. may not be a candidate, but in 30 days they are a candidate. AN example of this is if the pt. has weeping skin tears on the only arm that can be used , in the spot that you will place the line. Once the tears have healed, they probably will be a candidate. Luckily, we have a variety of lines to offer, so the MD  & the pt. has a choice.

Victoria Sallese, RN, VAT, PICC service

Craig Ewert
My wife developed the PICC

My wife developed the PICC program at our hospital (we are the PICC Team for our institution).  We set up PICC criteria we use with every evaluation order that we receive.  We treat every patient as an individual (case by case) but these are general guidelines we always use during the eval process:

1.  Because we use computerized charting we look for previous PICC attempts.  If a pt had an unsuccessful PICC attempt in the past we look at the documentation for the reason it was unsuccessful.  This saves the PICC Team time and the pt undue procedure. 

2.  Pt receiving irritant or vessicant medication  for a minimum of 5 - 7 days (pH too low or too high).

3.  Poor venous access, but pt must also meet guideline #2.  If patient has poor veins and only needs a short term access the PICC Team will place a peripheral line using ultrasound guidance.

4.  TPN

5.  Pt pending discharge for long term IV therapy with Home Health, SNF, or outpatient Infusion Center.

6.  Review pt hx:  PICC should not be placed on same side as lymph node removal in breast CA, avoid pacemaker side, PT INR should be less than 2.5

7.  PICC lines are considered non-emergent.  If the patient requires an emergent venous access a bedside CVAD such as a triple/quad lumen should be placed.

8.  If the pt meets criteria, the PICC Team RN will review pt need and line intention to determine which PICC to use (Groshong vs. PowerPICC).

9.  If pt does not meet criteria the PICC RN will document reason with recommendations for the more appropriate CVAD.  The bedside RN will notifiy the ordering MD.

 I  hope this helps!  It works very well for us,

Craig Ewert, RN


Craig Ewert
One comment I forgot to add

One comment I forgot to add is that our medical director is the Infectious Disease Specialist for our hospital and if we see that he is going to consult we usually  wait until he has seen the patient and deems a picc as appropriate before placing line.  He is also a great resource for us to review a patient with him if we have questions and he is not consulting.

Craig Ewert

Thank you Craig, that was

Thank you Craig, that was exactly what I was looking for.

Is this criteria an official document such as a policy?  Or is it something the team uses?  I know of 1 doctor in particular at my facility that will fight tooth and nail unless something is in writing.

Also, what do you do about your renal patients?

Sound like you and your wife make a great team :)

Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy

I do not think an INR being

I do not think an INR being high would prevent me from inserting a PICC line so I would reconsider your criteria in this case.  I think you should have a blanket statement allowing the risk-benefit to patients who are outside your criteria list

It is a good list however


by the way as a side note PICC's are often found to be ordered two days before discharge and than removed the next day but the patient was there a week.  Is that an inapproriate PICC or inapproriate process of assessment?  Thought to ponder

Kathy Kokotis

Bard Access Systems

Just thought I'd add that we

Just thought I'd add that we once received an PICC requisition for a gentleman that had no arms (but I don't think we'll add "must have arms" to our policy).

Mari Cordes RN

IV Therapy Team

Fletcher Allen Health Care, Burlington VT

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

Impossible is nothing
Impossible is nothing
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