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sue
PICC lines in ER
Hi All- I am wondering if in your hospital you place PICC lines in the ER, if you do, Why, and if you don't, why not?  I have always thought a PICC should be a nonemergent procedure but today got "bullied "into putting one in a patient in ER.  I would like some other facts to back us up as a team for not doing placements in ER.  I also do not consider it an ideal place for a sterile porcedure.Thanks for your time.  Sue B.
Robyn Whitlock ...
We are an independent
We are an independent company and we frequently get calls to place PICCs in the ER.  One hospital in particular has guidelines that state that the patient can't be sent to the floor without IV access.  What I usually find when I am called there is a patient with absolutely no access who needs to be admitted for several weeks of therapy.  We see alot of patients with a history of drug abuse with no access in the ER, also.  The ER nurses are great and they have usually attempted  to place a PIV.  Since we have a 4 hour response time, we are not usually called for ER patients who are crashing or need IV access within the hour in order to receive treatment.  As far as an ideal place for sterile procedures, I find the ERs to be one of the cleanest places around, with lots of room for setup!

Robyn Whitlock RN, MSN, CRNI

chirth
We don't generally place
We don't generally place PICC's in the ER as a rule.  The ER nurses are excellent PIV starters.  When they do call us, it's because the patient is truly an access challenge, or has a history of needing PICC's and will be an admission.  This doesn't always need to be done in the ER and can sometimes wait until the pt. is admitted, but sometimes the ER needs lab work or would like to begin IV therapy.  In an emergent case, the PICC line is not expected.  And as far as cleanliness, I have never considered the ER any less clean than the units.
Nadine Nakazawa
Like any request for a PICC,
Like any request for a PICC, you have to evaluate the entire situation:   the patient, their total IV therapy needs, need to access right now, and in the ED, the setting.   In some hospitals, the ED may have a quiet procedural area that will allow you to do it. 

In my hospital, the ED is always overcrowded and the key is turnover---trying to move patients either in or out as quickly as possible.   

Our ED does not allow for us to do our PICC insertion in an area uninterrupted; it's just too chaotic a place.

As always, it is up the PICC clinician to evaluate what is best for the patient, and in this case, it includes evaluating the setting.  Stand up for what is best for your patient.

Nadine Nakazawa, RN, BS, OCN, CRNI, VA-BC

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