We are re-working our patient education handouts. Currently we tell our patients not to lift anything heavier than 10lbs with their PICC arm. I can not find any research or statements to back this up. I do find information about rigorous excercise and repetitive motions but no pound limit. A coworker talked about heavy lifting and bearign down causing tip migration into the IJ. However by that measure, it should be no heavy lifting or bearing down. Period. Regardless of limb.
Is anyone teaching anything similar? What do you tell patients? Especially patients that use wheelchair/walker/crutches? Young moms with children?
As always, your input is greatly appreciated!
The evidence is the knowledge of the muscle pump action found in normal anatomy and physiology. Muscle contractions in the arm compresses veins causing blood to return to the heart. When there is a PICC inside those veins, there can also be compression of the catheter. This can lead to catheter movement either into or out of the vein. I can also lead to pinching the catheter like a straw forcing the locking fluid out and blood to reflux when the pinch is relieved. For these reasons patients should be taught normal activities of daily living and to avoid repetitive and excessive motion of that arm. There are no published limits on the max pounds that should be lifted. This work has never been done. In fact, this may not be of importance at all. And it will be affected by how well the catheter is stablized on the outside and correct tip location. Catheters in mid to high SVC can have tip migration more readily than those at the CAJ. Catheter movement can come from numerous sources including changes in intrathoracic pressure and injection induced catheter motion. So it would be difficult to isolate a specific # of pounds to lift. Use of a wheelchair should be no problem as this should not result in excessive muscle contractio. Use of a walker also should be no problem. Crutches can be a problem is they have not been taught how to properly use those crutches. There should never be any pressure applied to the axillary area with our without a PICC. Pressure on this region from improper use can lead to nerve damage. Pressure when there is a PICC in place can increase the risk of vein thrombosis. Normal use requires pressure to be placed on the hands and this should not be an issue either. This is all part of the pre-insertion assessment and complete patient education. Mothers with small children should have this taken into consideration before placing the PICC with the PICC being placed in their nondominant arm so they might be able to pick up the baby with the dominant arm. All of these factors are part of your pre-insetion assessment to determine if a PICC is the most appropriate for each patient. If there is any concern about of these or other issues a tunneled cuffed catheter may be more appropriate than a PICC. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
As always, Lynn, you are our voice of wisdom. Thank you for your extensive explanation. I am going to add this to my file of information for our PICC team!!