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achoosa1
Power piccs and normal piccs

I was told by my manager that we don't have policies to place power piccs at the bedside. Power  piccs should be done at IR. The other picc line nurse would place only triple lumen at the beside in the icu setting only. I don't understand the rationales. I also think that power piccs; single and double, should be used more in our facility.

Any thoughts? Thanks in advance.

Ann 

bnosal
What was the reason for only
What was the reason for only placing in IR? The process is the same for placing regular and power injectable.
achoosa1
They don't give me the

They don't give me the reason. That is why I am totally confused. I just started working in Jan this year.

Ann 

mary ann ferrannini
 If you have a P&P in place
 If you have a P&P in place for placing PICCs at the bedside you can certainly place power PICCs as well. One important thing that you did not mention is whether or not you are using US to place your PICCs. The Power PICCs (especially the triple lumen) should be placed above the ACF tovitually eliminate the complication of phlebitis. The insertion procedure is the same except for a product specific recommendations,such as use of clamps and trimming. I think your manager can be educated.
achoosa1
Hi MarryAnn, Thanks for your

Hi MarryAnn,

Thanks for your input. I use SiteRite 6 to place piccs. But we don't place power picc lines regularly. The other picc line nurse uses only triple lumen power piccs. She does not use single or double at all. Our inventory supplies only triple lumen power piccs.

It seems like a big deal when MD. had ordered a power picc. I am afraid to place the triple lumen because the vein needs to be big to accommodate the 6 Fr. One day,I had spoken with a sales rep and got the info that Bard has single and dual power piccs. That is why I would like to know the reasons for not using power piccs: single or dual as a regular basis when the patients need them.

Ann 

 

lynncrni
There are now hospitals that

There are now hospitals that use only power piccs in all patients. So I do not think this should be the issue. We do not have a crystal ball to determine who will need a CT and who will not. So many will use a power picc on all patients.

 The issue is the use of multiple lumens when they are not required based on the prescribed therapies. There is absolutely no reason to place a triple lumen catheter in all patients. This can put the patient at risk for thrombosis (larger outer diameter) and bloodstream infection (more lumens = greater risk of BSI). So if they are not required they should not be present. As always, the choice of size, lumens, and length of all catheters must be based on what the patient needs, not what is easiest to get. 

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

As far as insertion policy and procedure I see no difference in insertion between power and non power injectable PICC lines.  Is it a question of supply, money?

To be both catheters insert in the same manner

Kathy

Kathy Kokotis

Bard Access Systems

achoosa1
Kathy,thank you so much for

Kathy,thank you so much for your input. My manager does not do picc lines, so she cannot really give me the reason why. 

Ann

bnosal
Sounds like it's a simple
Sounds like it's a simple staff education issue.
Michael Drafz
Michael Drafz Vascular

Michael Drafz

Vascular Access Specialist

Sharp Memorial Hospital San Diego, CA

Michael Drafz RN, CRNI, VA-BC

Clinical Lead Vascular Access Service

Sharp Metropolitan Medical Campus

San Diego, CA

 

Michael Drafz
Michael Drafz Vascular

Michael Drafz

Vascular Access Specialist

Sharp Memorial Hospital San Diego, CA

We have been placing Power Picc's for some years no and do them almost exclusively. We have had too many patients having a Groshong Picc and then we had to place PIV's for CT scans. So even in terms of cost, if you add the additional supplies and time for the PIV start, I would argue that the hospital is loosing money, for sure if the Power Piccs are placed in IR. May be they are confused because they were first released for IR placement in an IR Kit (long wires ect.)

We are also placing many triple lumen Piccs, based on therapy needs. So not everyone in the ICU needs a triple lumen and sometimes the patients on the regular floors have so much iv therapy that they need a triple lumen. So you really have to assess the situation.

So if you are using ultrasound placement in the veins of the upper arms, there is no reason to have a blanket rule to not place certain types.

Michael Drafz RN, CRNI, VA-BC

Clinical Lead Vascular Access Service

Sharp Metropolitan Medical Campus

San Diego, CA

 

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