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Heather Nichols
To PICC or not to PICC

I am looking at starting to place triple lumen PICC's on ICU patients that met the required need.  My question is this:

  Since there is a much higher incidence of infection and internal damage from regular triple lumens, would it be more prudent to provide a triple lumen PICC for some patients (with a center lumen for power injection) or just place the regular teiple lumens.  At this time we check wht count, febrile status, creat, bun, and all cultures results.  We do not like to PICC patients that are bacteremic since the doc's like to pull our lines out in a couple of days due to that reason.  We feel as though the picc is a long term line and should be used as such. 

    I am not so sure now and am beginning to have mixed feelings, especially about safety issues such as lack of sterility, and internal damage done by the doc's.  What is everyone elses thoughts?  We also must consider the much increased cost of the triple lumen PICC, and the possibility that it will be sent to the regular floors for use.  Added lumens give possibility to more infection risk.  It is definitly a patient to patient assessment, but how do you actually weigh those risks/benefits?




We place triple lumen PICCs
We place triple lumen PICCs regularly in our ICU. we don't even carry a non-power triple. the doc's in ICU like to transduce cvp's with the power picc. we feel that the piccs we place are far less likely to source a bacteremia that the cvc's that the residents will put in. So we consider it a good thing. I don't see the triple "power" being a greater risk than non-power. Our double lumen power piccs have no higher complication rate than our non-power dl's. I think any picc we put in is going to better than a fem line, neck line or subclavian that the doc's wil place.
Nadine Nakazawa
Nadine Nakazawa's picture
Heather:   I see what your
Heather:   I see what your concerns are.   This would be a GREAT round-table discussion at AVA.   Suggest it to Doug Burns.   I think the complexity of the issues is ever evolving.   Nadine

Nadine Nakazawa, RN, BS, VA-BC

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