Forum topic

4 posts / 0 new
Last post
Robbin George
PICC vs New Pacemaker
Case: Patient has a 4 day old Pacemaker and a referring MD orders a PICC--Please advise what our response should be with rationales and evidence based references if they exist--Thank you in advance for your responses 
mary ann ferrannini
 We have this issue come up
 We have this issue come up all the time and is usually b/c they are have a pacer-related infection and are going to have a new pacer placed. This is what we do. We will not place the PICC until the cardiologist places the new pacer and removes old pacer. Then we see where we are at....and usually it is the old pacer side. We then try to place the PICC on the old pacer side. We sometimes find if there is quite a bit of swelling it will not thread past the subclavian area. When we tried to place the PICC with the old pacer in place our success rate was significantly lower,and that is why one of the reasons we wait until after the pacer is removed. An added benefit is that they have some antibiotics on board. You did not mention any particular scenario so I must say I would avoid the new pacer side and use the other arm. Our cardiologist do not like us to place PICCs on new pacer sides as they are concerned we will dislodge the pacer wires as they have not had enough time to heal. Once healed. I can tell you we have placed hundreds of PICCs on the pacer side and sailed right past them. If we get into a sticky situation and we are desperate for acces on a particular side we call the MD and consult with him or her about the options and then write an order to use that side.
Robbin George
It sounds like you are
It sounds like you are saying it is physician preference that guides your practice--Are there any evidence based studies that would give clearer guidelines?--What exactly is the contraindication to insertion of a PICC even on the opposite side and it's relationship to a NEW pacer? 

Robbin George RN VA-BC

Karen Day
Karen Day's picture
I think this is very much a

I think this is very much a physician preference.  We have asked our cardiologists and they prefer no picc on the same side as a pacemaker unless it has been in place for at least 6 weeks (one even prefers 12 weeks). 

I think the contraindication to placing a picc on the opposite extremity solely comes from the fear of a possible CRBSI with potential  contamination of the new pacer and I am just guessing here as a couple of our docs have casually mentioned this. I have had a couple of docs state they do not want the picc wire touching the pacer wires - nearly impossible since they both reside in the SVC - when they become this picky, I refer them to IR so they can be done under flouro.

We have placed picc lines in opposite extremities in patients that have had their old pacer removed and a new placed, we also prefer to wait until the old is out as well.  Sometimes we do have the difficulty of threading the picc where the old pacer was and I must say that every time we get an order in this particular patient population, we cross our fingers and hold our breath until the line goes beyond the subclavian area.

Log in or register to post comments