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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.

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., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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