When your doctors order, do they always specify the number of lumens?Â What if they don't specify how many lumens?Â What do you do at that time?
I would never look to the physician to specify the number of lumens for a patient's infusion therapy. A physician has no real knowledge of the technical aspects of infusing multiple therapies such as compatibilities and drug stability. This is a judgment call made by the person inserting the line. I would add a word of caution from what I have seen in some legal cases - the automatic use of only a dual lumen or triple lumen for all all patients is never the best approach. This requires a larger lumen which could be too large for some patients. Also, additional lumens provides additional areas of contamination and the infection rates with more lumens is greater. So this requires an assessment by an infusion nurse specialist. Funny thing how there is a growing need for this group yet many who are making the financial decisions just do not see this.
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 agree totally, Lynn. But we had JCAHO physician questioning who determined the number of lumens and he determined that the physician needed to decide that and write the order specifically indicating the number of lumens. He indicated that it should be a medical decision and not a nurse decision.
Our experience indicates the same as you said "a physician has no real knowledge of..."
We evaluate vein size without a tourniquet to determine what the selected vein can handle without compromise to the blood flow around the catheter. Based on that, we never place anything larger than the vein can tolerate. We have discussions with physicians if they ordered a triple and a vein will not tolerate that size. Also, we practice using the fewest lumens possible to accomplish therapy. Some patients don't need more than a single. We have discussed the CDC guidelines with physicians and told them that we will not place a dual when ordered, due to these guidelines.
I ask this question because we can't be the only ones that have had a JCAHO reviewer to ask this.
Wow, first I have not heard of this and am eager to know if others have heard this same thing. My first reaction is that the JCAHO physician surveyor was not in touch with the real world.
While I had a reviewer ask to see what our written policy was about how much time we required for antiseptic solutions to air dry, I have yet to have one say that PICC nurses shouldn't be deciding how many lumens.
I agree with Lynn's comment about the real world.
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center