What are your thoughts on placing a Picc line with a transcutaneous pacer? An external pacer? And also, what is your criteria on placing a Picc line with a brand new pacer present?
We have an online CE course written by Deb Richardson, RN, MS, CNS on this topic. YOu can learn more information at http://www.hadawayassociates.com/el_CVCPacemaker.htm
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 think that it is best to avoid the side with the pacer. However, I have discussed with cardiiologists and have "permission" to use the side of the pacer. Their thoughts are that the older pacers are endothialized and not at risk for being affected by the PICC. Is this our preference? No, but we have had situations of critical access needed and pacer present.
I have experienced failure to advance a PICC with a pacer on the same side. Also, I had great difficulty advancing a PICC this week on the opposite side of an AICD. The chest x ray illustrated the obstruction, the AICD leads. After much repositioning the PICC landed in the contralateral innominate. The PICCs were BARD power piccs (with Sherlock.)
I find that it almost never works to pass a PICC on the same side as a pacer so usually I will avoid the pacer side. The data that I follow are that you should not place a PICC on the side of a pacer unless at least 3 months have elapsed. Recently, I was faced with the decision about which side to use when the patient had a dialysis catheter on one side and a pacer on the other. I reviewed the CXR and it seemed to me that the Dialysis catheter took up much more vein than the pacer. I decided I may have better success using the pacer side. To no avail, the PICC would not go past the pacer. I had to use the side of the tunneled dialysis cath. of which there was no difficulty passing the PICC.
Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]