Forum topic

5 posts / 0 new
Last post
Would you place this PICC?

Surgeon asked for PICC placement in a 24 yo male with severe "road rash" across upper back and back of both arms bilaterally. During initial assessment in ED pt had elevated liver enzymes, low albumin, admitted daily alcohol use and urine screen positive for opiates with no history of opiate prescription.  Labs at time of PICC eval, 18 hrs post injury, show normal CBC and kidney function, liver enzymes improved but still elevated and albumin sl improved.  Progress note states PICC requested for out-patient administration of IV narcotic prior to BID dressing changes. Pt on IV Ancef but no plan for long term antibiotics at this time. Pt has adequate peripheral veins at present and discharge is in the next few days.

PICC team felt it might be more appropriate to administer PO or IM pain med 30 min prior to dressing change rather than place central line in this patient.

Any thought?


My main concern would be the

My main concern would be the fact that you say both arms had severe road rash.  I would not want to place a PICC in an affected arm unless it was an absolute last resort which it appears in this case it isn't.

Chris Cavanaugh
Why risk infection with a

Why risk infection with a central line (PICCs get infected too...) especially with questionable care, when PO or IM pain medication will work? 


Chris Cavanaugh, RN, BSN, CRNI, VA-BC

mary ann ferrannini
  cannot say I would

  cannot say I would absolutely not place it. My first concern would be his skin condition as skin disorders at or near the insertion site can be a contandication. If placed, could you find an insertion location that will allow for proper care of the site so infection risk will be kept at a minimum. Secondly, it is not fair to withhold pain relief treatment b/c you think someone might be using the line for narcotic or illegal drug administration. But, what you can do is find an alternate way or route. If is pain can be controlled with IM injection prior to dressing change I see no harm. Now if his pain cannot be controlled by this method I would either place the PICC or perhaps place a peripheral and send pt home with that,until that site outdated or needed restart. I would also need to have some kind of time frame of the proposed treatment schedule. PS would also have a chat with the MD and discuss my concerns!!

Leigh Ann Bowegeddes
Central access for this use

Central access for this use only is too much of a risk for any patient, regardless of drug abuse history. SQ narcotic administration is taken up as effectively and quickly as IV, in essentially the same dose. Why not just do this? It is nearly painless, and a much safer approach from an infection control perspective.


Leigh Ann Bowe-Geddes, RN, BS, CRNI

Vascular Access Specialist

University of Louisville Hospital

Log in or register to post comments