Does anyone have studies on outcomes of ICU patients with PICCS vs. non-tunneled CVCs? I am looking for the metrics influencing the INS recommendations for non-tunneled CVCs in ICU patients.
I work with many intensivists who regularly orders PICCs in critically ill patients when he does not have time to place a central IJ/fem. Despite my research and presentation of MAGIC/SHAE, ARROW device selection algorithms for best practice references, information from Dr. Chopra's website, www.improvepicc.com, INS, and discussion threads from Lynne, they want a hard number or statistics for the rate of complications from PICCs in ICU patients. The rationale is the risk may be warrented.
I am placing PICCs in septic patients, head bleeds, strokes, vessel to catheter ratios less than 45%, and trauma routinely despite voicing concerns about safety.
My reply to one MD was that the risk of complications with PICCs is so high in critically ill patients, they are not recommended. He was not satisfied with that answer. I told him DVTs occur in approx 7%-30% of all PICC patients. This did not concern him.
I am trying to determine our institutions baseline of PICC related complications (DVTs/CLABSIs) and dwell times but it's taking longer than anticipated. In the mean time I thought I'd reach out here to get input on developing best pratice VAD selection.
Best,
Kate
Look at the references after the statements in the INS Standards. That is the start. Then do a literature search on PICCs and critical care. There are numerous studies supporring this. Your message sounds like you are saying the catheter to vein ratio is a bad thing to be less than 45% or maybe I am misunderstanding your post. The catheter should consume less than 45% of vein lumen, so catheter to vein ratio of less than 45% is what you need. Lynn
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
You are correct, I mispoke on catheter / vessel ratio. Apologies.
Thanks for the advice. Feel stupid for not checking there first!
I hear what your saying and am also witnessing some dangerous trends. can I get your opinion on something? would you feel comfortable starting a PICC as a solo procedure without any assistance at all and without any other person in the room?
Single person PICC insertion is done frequently. But it is not best practice.
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