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Daphne Broadhurst
Repositioning a single lumen PICC

Would like to hear what others are doing/would recommend for repositioning of a single lumen PICC placed too deep (immediately after post-insertion CXR). Would you cut the catheter & replace the leg/hub so as to prevent a longer external length (rationale: the less external catheter, the smaller the risk of migration) or leave the catheter intact with a longer external length (i.e., 10cm) (rationale: catheter integrity remains intact, thereby reducing the risk of crbsi)? Thanks in advance for any replies.

Gwen Irwin
We don't use Groshong

We don't use Groshong catheters, so we don't have the option of cutting the external catheter, therefore we do have a longer external length.  We have not experienced any risk of increased CRBSI with this practice.

Gwen Irwin

Austin, Texas

lynncrni
I would not cut the external
I would not cut the external hub off and apply a repaired hub. In my opinion, this presents a greater risk than having a small length external to manage under the dressing. Lynn

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

Glenda Dennis
I leave the guidewire in for
I leave the guidewire in for my cxr, maintain a sterile field with 4x4's over and under the catheter and my drape in place, take the cxr, read my cxr, and make any adjustments necessary before putting the hub on.  I use ultrasound to check the IJ before calling for the cxr.  This is all facilitated by doing as many PICC's as possible in radiology so cxr is readily available.  Works great if you can do it.  Radilogy likes to get the procedure revenue.  Of course, I can't handle patients this way if they are in ICU or isolation.  Takes a bit longer if cxr has to come to my patient.
rivka livni
If the catheter needs to

If the catheter needs to come out more the 3cm, we exchange to a shorter one.

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Most pull back anecdotally.  Re-x-ray after pull back.  It depends on how deep and how much left out in order to exchange. 

 As far as radiology gets revenue on PICC line insertions they do not.  There is no reimbursement for a PICC line done in IR even by a doctor for the hospital that is.  PICC lines should never be placed in an IR setting if it can be avoided as it is a high cost to the healthcare system.  Patients are primarily based on "DRGs" today for reimbursement so there is no reimbursement for any central line placed on an in-patient including a port.  PICC LINES do not belong in the IR I suggest looking at your facility payer mix.

Kathy Kokotis

Bard Access Systems

Dawn1
I would like to know what

I would like to know what others are charging for picc exchange. If I do a picc exchange at time of insertion say for a too short of catheter, do I charge my regular picc insertion charge? do I add a picc exchange charge? If I do a picc exchange a couple days later, do I charge a picc exchange? If I'm unable to thread the catheter all the way, I make a referral to radiology & they do a picc exchange & they have a separate charge for picc exchange. Should I be using the same picc exchange charge as our radiology dept?

Thanks,

Dawn

PMRMD
Use of ECG guidance during

Use of ECG guidance during placement would avoid the need for chest x-ray altogether. As I've posted on other threads, there is close to 100% correlation between ECG guidance and echocardiographic tip location (see http://www.pacerview.com/index_files/ECG_GUIDANCE_FOR_CVC_PLACEMENT_IN_THE_LITERATURE.htm) while there is only 80% correlation between chest x-ray (our current "gold standard" !) and echocardiography (and only about 60% between surface landmarks and echo). It's faster (saves 30-60 minutes / procedure since there's no waiting for an x-ray), less expensive (about $21.00 total per procedure), works with any open ended catheter with a non-insulated guide wire from any manufacturer and gives immediate feedback so you can leave the bedside knowing you are in proper position.

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