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When PICCs & Pacer Collide

I could use some guidelines when a new Pacer is placed. To my knowledge (limited), no PICC line when new Pacer is placed till after about 30days have passed. Just recently I have had two orders for PICC when the Pacer was placed just the day before. I thought that in doing so there is risk of dislodging the leads. What guidelines are you using in this situation and what other contraindications are there? Should I get cardiology approval? What other choice is there for long term antibiotic - midline?

Debra R.

Long Beach Memorial Med. Ctr

Long Beach, CA


 There is very little, if

 There is very little, if any, data published out outcomes in this situation. I have heard most cardiologist recommend at least 6 months after pacemaker insertion before a CVAD is placed. The leads must have time to implant into the cardiac muscle. There is one case report of thrombus formation between pacer leads and a CVAD that caused the lead to fracture upon removal. I would definitely get feedback from the cardiologist. I would also assess for the possibility of a midline based on all factors - drug osmolarity, pH, # of veins accessible, length of anticipated therapy, etc - and make the decision based on the risk vs benefit analysis. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

We always check with

We always check with cardiology, get their approval and document it. We have never had them say no even on a brand new pacer

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