Upon evaluating a facility regarding best practice with vascular access, we came upon one that places PICC lines with patients in various positions including sitting up. When asked about the rationale to put patient supine or HOB in lowest position possible, I was unable to find literature on this. Can anyone help me with this?
Thank you
I don't think you will find any evidence saying that flat with HOB in lowest position is required. Use what is most comfortable for patient. I have often had head elevated when placing PICCs based on what patient needed. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thanks, Lynn. Yes, depending on comfort and respiratory challenges, I have also put in PICCs with patient in various positions but I do try to get them in lowest head position that they can tolerate and extending arm the that is tolerable. I think we all have had the contractured patient that can be quite a challenge. This being said, in the facility I was talking about, the nurses always put patient in higher positions and have quite a problem with advancing line around shoulder. Upon thinking about anatomy, I think by head lower and arm extended as tolerated, they would have less problems. I have made some adjustments such as this with aid of fellow inserter and this did, indeed, help to advance line. Hmmm. Wish I was still clinical. Would be easy study.
The reason we have always made the standard position for PICC line insertion supine is to reduce the risk of air embolism. Infact it is part of HCA air embolism prevention protocol
There certainly are patients that we keep HOB elevated etc due to medical conditions, issues...but of course that is individualized and then documented.
Gina Ward R.N., VA-BC
A PICC insertion site is at or below the level of the heart, unlike a subclavian or jugular insertion site. So the risk of air embolism on insertion is not the same as with those other sites. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861