I would like information on what other hospitals are doing when there are numerous unsuccessful PIV attempts made on a patient for a CT with IV contrast and then a physician writes for PICC placement just for the scan and then to be removed. This seems like such a misuse of PICC lines and an unjustice to the patients vasculature but in discussing with the M.D. there is "No other Option". Would love some feedback on either policies or procedures that I could use as resources or just any solid information.
Most are using ultrasound to place a peripheral catheter for CT instead of placing a PICC when the CT contrast agent is the only infusion therapy needed.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Darla Tarvin RN VA-BC
Mercy Clermont Hospital
Karen,
I was wondering if you are referring to PICC or PIV using ultrasound? If it is a PICC I understand your point but how often do you think the test is positive and the patient keeps the access?
We have been faced with these same issues. We started placing PIV using a longer IV catheter - but it seemed that they would still infiltrate easily. We finally decided to only place ultrasound guided PIV's in superficial veins such as the cephallic. We were very concerned over contrast infiltrations(vesicant) in deep veins and their close proximity to nerves.
Can someone direct me how they obtained competency in placing USN guided PIV?? What were the steps to get this started for your team as we are interested in this at our hospital
The decision of PICC versus PIV for CT contrast injection must be individualized to each patient correlating comorbidities, history, and present peripheral vascular presentation. A risk versus benefit approach for each individual. Contrast agents with an osmolarity rate >600 fall within INS standards of central vein delivery. Contrast extravasation can be devastating, even a low osmolar nonionic agent infiltration has potential serious damage depending on PIV location and amount of contrast. Remember the contrast is power injected, warmed but viscous infusate at about 5ml/sec. First do no harm.
Hope this helps.
Timothy L. Creamer, RN
Clinical Specialist, Bard Access Systems
Florida Division
Timothy L. Creamer RN, CRNI
Clinical Specialist, Bard Access Systems
Florida Division