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maggiemae
PICC lines and MD beliefs

i have an MD who orders only single lumen PICC's, under duress.  example: pt vented, three peripheral lines, 1 femoral triple lumen, art line. meds vanco, cefepime, flagyl, norepinephrine, propofol, cardizem, fentanyl.  wanted to get rid of the femoral triple lumen. ordered a single lumen PICC, (Bard).  called her back and asked for a double lumen.  she denied stating the dual lumen is known for more infections and thrombi.   approached with meds and compatabilities, vesicants, irritants, poor vessels, long term need.  still only wanted a single lumen.   How and what can i give her to approach the .35mm difference in a PICC size, advantages, and need for access?   I have not heard of the dual lumen 5 Fr causing more infections.  BTW--our record after 5 years of PICC insertion is 0 infections.  Please help.

lynncrni
More lumens do increase the

More lumens do increase the risk for infection due to more hubs to use and contaminate. But the risk of this must be assessed against the risk of more insertion sites. You have more lumens with the way it is now being done. YOu also must be measuring vein diameter and placing a PICC that only consumes a third of the vein lumen, known as catheter to vein ratio or CVR. Filling more than a third greatly increases the risk of vein thrombosis. It sounds like your physician may have just enough knowledge to be risky but not enough about all VA risk to make the most appropriate decisions. Dual lumens do not increase risk of thrombus; catheter to vein ratio does. But you can find a small size dual lumen that will work for most patients. But the bottom line is that a PICC is not the most appropriate VAD for critical care patients as this group is more at risk for thrombus formation. 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

alison57
Critical pt

I'm not a critical care RN

is a Hickman a preferred access then?

lynncrni
No. First make sure a central

No. First make sure a central line is what is needed based on numerous factors. If yes, then a low IJ insertion site is best for patients at increased risk for thrombus (eg critical care and oncology). Low IJ can be easily curved and secured and dressed on the shoulder and eliminate the problem with neck motion. Many infusion/VA teams are now doing this. Tunneled cuffed CVAD (Hickman®) is a surgicall inserted CVAD for long term use. Critical care patients are probably not going to have long term need. 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

JackDCD
Maggie,

Maggie,

She's ill informed. Look, this is not new. PICC lines have always had risks. But, we are way too focused on what "could" happen that we lose sight of what is better. Keep in mind, all surgery has risks, but we haven't slowed down doing surgery. We do our best to protect against the risks, but what we are doing is practicing medicine based on those risks.

So we lose what's best for the patient. The PICC line is still the BEST tool in the vascular Access tool-chest, but if that tool is associated with a potential harm they we need to get better eliminating that potentional NOT throw out the tool 

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