I am noticing an increased number of piv's and IO placed in the upper arms of patient's and then receive orders to place a picc. How far away from existing piv's and IO should a picc be placed or should those extremities be avoided all together. Which has greater risk of blood stream infection? An IV in the upper arm with a picc or an IO in the upper arm with a picc. I really don't like either option. Unfortunately they place all these in a pinch then ask me at a later time to place a picc for more lumens for ICU patient.
I am not aware of any guidelines addressing this. I think it is an assessment of each patient's risks and the benefits from the PICC. IO should only reside for 24 h, so by the time you place a PICC it should be removed. PICC also should mean that the PIV can come out. If those sites look ok without any signs and symptoms of complications, I think it would be acceptable to place a PICC in the same arm.
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
thank you Lynn. With that said, how close to an existing piv or IO would you consider placing a picc and would you place a picc in the samevein when the existing piv is in the basilic vein you plan to use for picc placement. PIV's in bilateral upper arms. Also know that the patient had a fever of 102.1 the morning after the IV's and IO was placed. Now the patient does have possible aspiration pneumonia but would you be worried that the elevated temperature could be the result of lines placed under less than ideal conditions?