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mary ann ferrannini
repositioning after PICC Insertion
 I know this is a sensitive subject but I would like to know what other facilities are doing. I have been placing PICCs since 1989 long before we used Ultrasound and microintroducers. After we got our DL Groshong in  with the 12 gauge nail (at least it seemed that way at times) we did everything possible to preserve and maintain that access. If we did need to reposition say for example advancing from upper SVC to Low SVC  we did so in a timely manner. My question is.....what time frame are nurses using (if at all ) for advancement. I am talking about right after obtaining and viewing the CXR. I know some say never do this I know some wrap the external visible with gauze ..I know some say you have 2hours or 4 hours or whatever. With all the advanced technologies we use now it is fairly easy to re-do if needed. I would like to avoid exchanging the entire catheter the next day because of a mismeasure. And yes we are using the Sherlock.   Tx would appreciat the discussion
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T. Nauman RN, CRNI  IV

T. Nauman RN, CRNI  IV Educator SHMC Eugene, OR

We, so far, have the ability to stay with our patient until final confirmation of tip placement...so we wrap the arm and the PICC in such a way as to avoid catheter contact with the skin...then wrap the arm in sterile towels.  We get a portable x-ray within 15 minutes...usually sooner, so...we do advance the catheter if necessary.  If the catheter stays in contact with the skin under just a small dressing, I'm not sure that advancing at all is acceptable...I don't have any proof literature, however.

T. Nauman RN, CRNI

mary ann ferrannini
Unfortunately we do not have
Unfortunately we do not have this kind of time we are too busy running to the next PICC. We order our CXrays STAT but the med-surg areas are usually last and a STAT often is done 1 hour after insertion. Three of are placing 150-180 PICCs per month plus all of our other duties
kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

There is no magic time period - wrapping in towels is not acceptable today to maintain sterile field

Once in - no advancement period only exchanged if too short

should I was an Infection Control RN for four years

kathy

Kathy Kokotis

Bard Access Systems

PMRMD
You might consider ECG
You might consider ECG guided tip location, a technique that gives you immediate feedback rather than incurring the delays (and expense) of CXR's. If you look at www.cja-jca.org/cgi/content/full/53/10/978, the P wave of an ECG can document tip location with a high degree of accuracy in real time. The technique has been available since the 1940's, popularized in Europe by BBraun (see their Certofix catheters - www.cvc-partner.com) and in the U.S. (www.Pacerview.com).
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