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Jenny Graziani
Numerous PICC line insertions in oncology patients

Hi everyone!

  I am having an issue at my hospital regarding PICC lines and oncology patients.  I would love some feedback to make sure I'm on the right track.  When I place a PICC line in an oncology patient for treatment, the oncologist orders the PICC line to be d/ced even when the patient is due back in two weeks for another treatment.  I have one patient that had 5 PICC lines in 4 months.  They have even asked me to place a PICC line for one dose of chemo and then d/c the line!  We have tried to suggest to the oncologist that these patients are at higher risk for infection because of the frequent insertions, but the answers I got were "these are CANCER patients" and "Just tell her to Put The Line In".  I think that these docs are equating PICC dwell time with traditional central line dwell time.  Am I off track with the thought that the purpose of a PICC line is for longer term access with these patients?  Not to mention the financial or emotional aspects of repeated line insertion...  How should I proceed from here?  Any resources to utilize or feedback is much appreciated!

Thanks !



The Cancer Clinic here

The Cancer Clinic here contracts with the hospital for PICC insertions. The people have their PICCs for entire treatment, even the people who have chemo with week 1 and week 5 of radiation (3 weeks of no PICC use). People either go to the Clinic for weekly drsgs or home care is arranged for non-chemo weeks.

Often have PICCs for 4-6 months, occas for a year of treatment.

I'd be worried about vein damage and increased risk of thrombous (as I'm sure you are) more than infection, assuming the oncology area is using good technique.

Of course, I'm in Canada, costs may not be an issue there if HMO is paying, as compared to it all coming off the agency budget. I'd think you need to stress health care reasons.


Perhaps your physician does

Perhaps your physician does not understand the capabilities of a PICC. Have your tried to discuss this with him/her to learn more about why they are ordering PICCs in this manner? Until you understand their thought processes, you really do not have enough information to formulate a strategy for dealing with this situation. If this is a situation where the physician will not share their thoughts, then you have every right to refuse to do something that you know to be dangerous practice for your patients. This risk with multiple PICC insertions would be excessive vein trauma and subsequent thrombosis. I would be more concerned about bloodstream infection though if the catheter is left in place for weeks or months. It could be that the doctor wants the security of a PICC for chemo but does not want the patient to have to deal with routine dressing changes and flushing between chemo courses. If this is the case, an implanted port would be a better option. Or maybe they are concerned about CRBSI and do not want any catheter left in place. So I would try talking to them first. 

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

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

 I hae been

 I hae been experiencing similar issues with our oncologists. I think that with what we know about biofilm and the higher risk patient population of oncology the docs over riding concern is infection. We all have had many patients that have had PICC lines for extended periods without infection. Do we have evidence based practice that is based solely in this population? What are the rates comparing this population to other diagnostic groups? Lots to think about.

Jose Delp RN BSN

Clinical Nurse Manager IV Team

Upper Chesapeake Health

Jose Delp RN BSN

CliClinical Nurse Manager IV Team

Upper Chesapeake Health

We also do this frenquently

We also do this frenquently and it often at the request of the Patient. Why leave a  PICC line in for 2 weeks not being used and increase your risk of infection. Many of these patients have had ports and would rather have a picc line even it is only in for one dose or one week. Placement of a port often requires surgery, anesthesia or at least deep sedation (there is a whole different can-o-worms). Many physicians are uneasy giving some chemo agents through implanted ports due to the risk of extravasation.

Jeffery Fizer RN, BSN

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