We are wanting to increase our trauma level at our 250 bed hospital, so we've recently hired on several intensivists that will place subclavian CVC's (using u/s) around the clock as needed for our ICU patients. Thus, I've seen a dramatic decrease in the number of PICC requests from that unit. I'm currently the only FT PICC nurse placing about 40-50 PICC's per month. I've tried to inform the ICU staff that PICC's are capable of CVP monitoring with accuracy, and that studies have shown that there is less risk of infection with the placement of PICC lines vs. CVC's.
Does anyone have a policy in place with criteria that is used to determine whether a patient is a better canditate for a PICC vs. subclavian line? I'm trying to grow our bedside PICC program and would appreciate any advice/studies/articles etc. that anyone has to offer.
Thank you,
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland
Fewer insertion complications with PICCs. You can not drop a lung with PICC insertion, however the use of US will also help reduce that risk with subclavian/jugular sites. The infection rate in hospitalized patients with PICCs is about the same as other percutaneous CVCs. So not much difference their. In my opinion, it should depend on what is the best thing for the patient. If they need rapid infusions of large quantities of fluid and blood, a PICC is not indicated as the flow rates will be too slow. If there are reasons to avoid Trendelenburg placement (increased intracranial pressure, pulmonary issues, curvatures of the spine), then a PICC would be better for the patient. If there is a trach, a PICC is better. Finally, those intensivist are there 24/7. What is your schedule? If you are not available on the same schedule, why should they wait for you to arrive for a PICC insertion? A critical care patient can not wait. So it should all come down to the patient needs and nothing else. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you, Lynn. I agree with you, and I thank you for your expertise!
Ann
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland
Impact of Peripherally Inserted Central Catheters on Catheter-Related Bloodstream Infections in the Intensive Care Unit
Bhavesh M. Patel, MD, FRCP(C), Corinna J. Dauenhauer, RRT, Mohamed Y. Rady, MD, PhD, FCCM,
Joel S. Larson, MD, Tonya R. Benjamin, RN, Daniel J. Johnson, MD, and Richard A. Helmers, MDJ Patient Saf & Volume 3, Number 3, September 2007
We have seen a maked increase in our ICU....but the nurse in the units love PICC and seem to steer the referal ship!