Hello,
At my facility, I have seen PIVs placed in the AC area below a PICC line or AC PIVs left in after a PICC line placement in that arm. My concerns are that there is increased risk of infection with the use of the PIV in the same arm and that, if there is an infection, it will be difficult to determine which line the infection came from. I have done a literature search without any luck at finding information on this practice. I have also posted this question to the INS Clinical Forum, but I have not had a response as of this date. I am wondering if anyone else might have some insight into this practice or policies in place to address this practice. When I made rounds today, I noticed four patients with this situation. My thoughts would be to remove the PIV as long as the PICC line provides enough access for patient therapy or, in the event of the need for more access, not to place the PIV in the same arm as the PICC line. What are your thoughts?
Thank you,
Pam Weber, RN
In my opinion, this is a dangerous and totally unneccessary practice. If the PIV is in the same vein being used for PICC insertion, the PIV couold easily be damaged during PICC insertion. The presence of the PIV and dressing could compromise the ability to do a thorough skin prep prior to the PICC insertion. I would worry more about superficial thrombophlebitis, but infection is also a concern. Also with the PICC, there should be enough lumens to meet the patients needs and the PIV is just not needed, so it should be removed. 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
I have experience with a PIV that was left insitu in the AC area below the PICC
It was subsequently used for a blood transfusion and resulted in an infiltration that compremised the functionality of the PICC
Consequently I ALWAYS remove any PIV in the PICC arm and place signage above the bed prohibiting use of the extremity for either tourniquet or cuff use
Robbin George RN VA-BC
Robbin George RN VA-BC
How many times have you removed a piv from the ac space and pulled a nice clot hanging off the end? I've seen it many times, and I don't want that thing on my picc. My preference is to remove the piv before the procedure.