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Leann Kennedy
PICCs placed in ED

Hi Everyone!

Happy "you are all awesome" day.  I was wondering if any of you have "issues" with placing PICCs in the ED.  This happens at our facility if our outpt facility cannot place the PICC line in a timely manner.  Instead, they will send the pt to the ED and have it inserted by the inhouse team, or admit the pt instead.  The ED has expressed concerns such as "all ED lines are dirty" etc, which I tend to agree with, especially since a lot of these lines will be used for chemo.  Before I tried to solidify a policy of some sorts, I wanted to ask if anyone else has a similar policy I could use for a reference, or even a reference article showing increased infection risks for IV lines placed in the ED. 

Thanks, as always, for the help.

Glenda Dennis
When I am asked to place a

When I am asked to place a picc for a patient in the ER, I generally move them to a private room there or I take them to a procedures room in Diagnostic Imaging for the procedure.  I won't place a picc in a multi-patient room in the ER.

DCrni
We have the same concerns but

We have the same concerns but find we are getting more and more calls to place PICCs there.  If the patient is going to be admitted we try to make sure they have IV access and insert the picc once they are transferred.  If not possible to delay then we ask them to find the cleanest room and just do the best we can.  Our inpatient double rooms are not much better than some of the areas in our ER. 

Outpatients coming in for picc replacement is another issue. The ED obviously doesn't want you tying up a room to do a picc.  If this is a trend from a particular agency or doctors office perhaps you need to work out a plan with them to better deal with these scenarios. 

My favorites are the clotted piccs sent to the ER from the home care companies because they don't have a protocol for giving tPA.  Talk about wasting healthcare dollars.

 

Good luck.

Darilyn Cole, RN, CRNI, VA-BC
PICC Team Mercy General Hospital Sacramento, CA

 

coffeemania
Same

I am doing the same. Can't do PICC in that environment with fruit flies flying around.

Cherokee people
PICCs placed in the ER

I won't say that we never place PICCs in the ER because we have a few times, but we don't place PICCs on outpatient's. If the ER calls and has a patient that needs a PICC and is going to be admitted in to the hospital what we usually do in give them an IV with the use of an ultrasound if needed and place the PICC at the bedisde when the patient gets up to their room.

We have the same infection concerns placing PICCs in the ER as expressed here. We have (years ago) placed PICCs in another area and sent the patient back to the ER. They received their IV meds/sol , PICC was removed and the patient was discharged. That happened on several occasions. PICCs should be used for long term not just for a few hours. Is this the appropriate thing to do? Would this not damge the deeper veins over time and make it difficult to place PICCs in the future? We don't have a policy stating we don't place PICCs in the ER. This was a problem that was discussed with the powers that be and the above solution was made. Just my 2 cents worth. Hope it was helpful to you.

Rhonda Wojtas
ED

To the questions of placing PICCS in the ED, i say nevre say never. If we have patients that will be holding for a few hours yes I will. And the ED will put the patient in the leaset congested area. I make sure I clean any surface that I will be using. There was alos a patient that weighted over 600 pounds one day that needed a line. There was no other option than a PICC line. One stick and perfect placement in 20 mins. What are the other options? Femerol?? Jugular? Subclavin? You weren't going to find any of these in this paitent.

 

To the second question, we do outpatient PICC lines as they are acctually a money generating procedure. Our patients come in thru our Ambulatory Care or Same Day Sugery floor and we do them there. One of the PICC nurses is also and Endoscopy nurse so we will at time do them in a recovery area of the endo unit if they are done for the day.

Rhonda Wojtas, RN VA-BC

Alma Kooistra
We place outpatient PICCs in

We place outpatient PICCs in the outpatient infusion center.

Alma Kooistra CRNI

blodahl
PICC Placement in the ERDept

Our ER has private rooms for most of the patients - glassed off doors to hallway. We don't often place PICCs down there, but we will if patient is a known horrible vein status and awaiting in-patient room assignment, etc.

Barbara

Karen Day
Karen Day's picture
OOHHH, don't even get me

OOHHH, don't even get me started about wasted healthcare dollars.  I can't believe they send these patients to the ER either, but what is worse is our ER director adamantly REFUSES to let her staff be trained on how to declot catheters or barely anything pertaining to a picc line.  Unfortunately, our picc team is not available on weekends or nights, so what happens to the patient that gets an occlussion on a Friday evening - they have to spend their entire weekend in the ER getting their antibiotics administered because the HH won't start a PIV and the ER doesn't know how to restore patency to their catheters!!! such a shame, recently had a pediatric patient this happened to and she ended up in the ER friday evening, they tried to painfully start a new PIV on her 3 times and were unsuccessful and she ended getting her meds IM for 3 days - on Monday, came to see me and I had her fixed in less than an hour.  Dad was furious because he had to spend 4 - 5 hours each day waiting in the ER - can you blame him. 

Anyway, back to the original question, we don't place a lot of picc lines in our ER either; however, our rooms are completely private with each one glass enclosed - so for patients being held in the ER awaiting a bed, we will place a picc line - but generally, if we can, will wait until they arrive to the floor.

thanks for listening to me vent!!

 

Gwen Irwin
PICCs placed in the ED

We have been called more and more to insert PICCs in the ED.  They aren't getting IVs in place after multiple attempts.  Due to that lack of access, they are requesting PICCs and then, the patients are being admitted.

After reading all of your comments, I hate to admit that I never thought of any of that.  We haven't any of the patients done in the ED develop a BSI.  I am grateful to say that.  Lucky?

Gwen Irwin

Austin, Texas

VAT RN
We place them anywhere I can

We place them anywhere I can setup and maintain a sterile field. IE: close the door, turn off the fan, etc. Our ER has areas that are cleaner and nicer than many inpatient rooms. They get wiped down far more often. ER does not equal dirty. Hastily placed lines with poor technique ARE dirty no matter what room you are in. There is no magic that occurs in a floor room to make it cleaner. For me it is more about the physical space, patient cooperation, foot traffic, etc.

lynncrni
I would totally agree with

I would totally agree with Martha's comments!! Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

glenda
Piccs in the ER

I do understand there may be a reason for picc insertion during a patient's visit in the er, rarely but possible. IE lung puncture risks.  But in our Er that turns over patients so very fast I cannot condone Picc insertion as a rule in the ER.  I have suggested to bring the patient into Pacu or someother place if The patient cannot wait until he or she is in their room.  I would  like to create a policy that reflects the above issues and would appreciate any help.  Everything I present must be saturated with best practice policy.   Never results soon if possible, making a point with MDs.  thanks glenda spn RN

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