Forum topic

All of the 6Fr TL's that I have placed have been in the ICU's. If it were up to some of the ICU nurses,in fact,every PICC I place in a unit patient would be a TL Power PICC. They are nice devices for the units as the really sick can end up gettting 5 or 6 drips at the same time,so the 3 lumens are nice. The center lumen is power injectable which helps for the chest CT's. Now that the surgeons know we have the open-ended catheters,we've had a few requests for lines for CVP readings.

We use all of our central lines for blood sampling,including the TL PICC's. Procedure is the waste method--flush,waste,obtain sample,flush again.

I agree with David.  All of the triples have been placed in ICU.  All of the ICU nurses would like to have the triple.  We do insert them for multiple drips that are incompatible, but find that usually a dual is all that is needed.

Doing lab draws from the largest lumen has not been a problem.  Rarely, there are patients that the ICU nurses use a VAMP device for lab draws from the PICCs.  Otherwise, it is blood waste from the large lumen, waste, draw the specimen, and flush.

Hope this helps.

Gwen Irwin

Austin, Texas

What are the long term complications of placing a triple lumen PICC in our ICU patients? These triple lumen PICCs taper to a larger French size then most triple lumen central lines and are going into much smaller veins. I understand the desire for the ICU nurses to have more lumens, but what is our responsibility as the inserter to the patient? 

Eric

Eric-

As for long-term implications or complications,I haven't seen any significant problems with the catheters. Last year I had one in a patient for 90-some days and aside from a lumen needing to be TPA'd once or twice,it served her well with no problems to the day she was discharged.

As far as the tapered end,yes it's a bigger gauge but the idea to the taper is to plug the subcutaneous tract,not stick the full length of the tapered portion into the vein. To do this well,you need to be very adept at measuring and trimming the catheter to the correct length. "Measure twice,cut once"--I learned that in shop class but it applies to PICC's as much as to 2X4's. The other part to this issue is selection of the vein in the first place. There have been plenty of discussions about vein size vs. catheter size--whatever size catheter you use,if you put it into a vein that is too small relative to the size of the intended device,it's asking for trouble.

In regards to our responsibilities to the patient,they could fill a book. I sum it up thusly "Place the right device in the right location at the right time and do it the right way."

Regards

David