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Kimberly K Dockery
requesting picc
This has been discussed before I am sure but I am trying to develop a procedure for nursing staff to request PICC or central line placement.  We are a small facility that has 2 people to place PICC lines.  Does wanyone have anythingto share regarding number of attempts before requesting lines or type of medications and length of therapy etc.?  Thanks for any help  Kim Dockery
Angela Lee
If you use the search

If you use the search feature and look for PICC assessment tools you will find some answers to your questions that have already been written.  There are some decision trees that can help and I know Bard has an excellent program on early assessment that they should be able to share with you.

Several factors need to be considered.  PH and osmolarity of infusants/medications, length of therapy and available access are some of those.

From a pediatric/neonatal perspective I do not want to make that decision based on a certain number of PIV attempts.  Once a patient has been stuck numerous times there is usually nothing to PICC since we utilize the same veins.  The key is to place the PICC prior to all those attempts and thus, preserve veins instead of destroy them.  I think that it's not much different in the adult world.

Angela is correct. The goal

Angela is correct. The goal is to be proactice and choose the most appropriate catheter capable of reaching end of therapy with the minimal number of catheters used. The operational costs for insertion of a PIV is around $40 now. So even 2 attempts has cost your facility ~$80. 

One approach is to take a look at which patients get the most venipunctures now. Divide this by diagnosis and by drugs. Each morning, the infusion nurses gets a list of patients with those Dx and drugs. Those are the patients they target for an early assessment of vascular access needs. Then they seek an order to place the most appropriate catheter as early as possible in the course of their stay. So this is much more than just the number of venipuncture attempts needed. 


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

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Re:  number of attempts
Re:  number of attempts before requesting PICC.  In this faciity we absolutely try to instill in the nurses that they do NOT have to try xx amount of times before calling the IV team.  We assist with PIV's as well as palce PICC's.  In trying to be a patient advocate there is nothing worse for the patient than a nurse who does her "mandatory" attempts all th e while knowing that there's no way she's going to get a vein.  We would much rather work with someone who's not PO'd because they've been unsuccessfully stuck a bazillion times.
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