Would like everyones input on what your practice is on leaving the guidewire in or not for the verification of tip placement. Have been inserting PICCs for 3 years and when was inserviced was instructed to pull the wire as it could lead to increased clotting. The radiologist are know wanting us to leave them in until after the CXR. What are your thoughts on this?
Carol Busch
Hello,
At my center, we never leave the guide wire in after placement and personnaly, cannot find a good reason for doing so. If the catheter is misplaced, it cannot be repositionned anyways - as the site was covered and the sterile field remove.
Does your radiologists want to keep it in to facilitate tip visualisation? If so, which picc are your using? I read an article once and the authors were refering to PICC as Practically Invisible Central Catheter... They went to the Groshong because it is easier to visualize.
France Paquet,
Clinical Practice Consultant, McGill University Health Center
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
Carol,
If the arrival of the radiology tech can be coordinated with the conclusion of the line insertion, we have found that leaving the guidewire in for the CXR can be very helpful to the radiologist to visualize the PICC in obese patients. This is not a routine procedure, and is evaluated on a case by case basis.
Lynda
Carol,
If the arrival of the radiology tech can be coordinated with the conclusion of the line insertion, we have found that leaving the guidewire in for the CXR can be very helpful to the radiologist to visualize the PICC in obese patients. This is not a routine procedure, and is evaluated on a case by case basis.
Lynda
Do you mean the stiffening wire (the one inside the PICC). Because the guide wire is the wire that goes through the access needle and should not be advanced past the shoulder (per INS).
Our team does leave the stiffening wire in on bariatric patients or patients we worry may be difficult to visualize (EKG wires, NG tube, ET tube, sternal wires, etc). However, our CXR's are ordered as stat portables and we usually have a report within 1 hour.
Martha
This practice began when PICCs first began back in the late 1970's. I used this on every patient back then. Infusion nurses inserting the PICCs were going to radiology to assess tip location and we needed to see it very well. We used sterile 4X4's to encase the external PICC, etc. You do not want it to touch the skin or it will be contaminated and you can not move it in or out if the tip is not in the correct location. After the 4X4s we would then wrap the arm with Kiling, Kerlix or sterile towels. Sometimes the patient went to xray and sometimes we did a portable, depended on patient's ability to move. The infusion nurse always went with the patient to ensure they did not do anything crazy with the arm since the stylet wire was still in place. All chest xrays were ordered stat, but remember the inserting nurse was looking at the film. This meant we did not have to wait for the radiologist to give us a report. Time is important if you do leave the wire in place as there could be blood reflux, but there are some stylet wires that allow for flushing around the wire inside the PICC lumen. The pro for this practice is easy visualization of the PICC and the ability to move it if it is not in the correct place. The con is that you will need to set up a new sterile field to finish the procedure because you should not allow any sterile field to go unattended while you take the patient to xray. Now there are other technologies that have taken the place of this practice, including ECG confirmed tip location. I would never allow a PICC to wait for longer than 15 to 20 minutes with the wire still in place, so you must have a rapid turnaround on the xray results. 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 for all the responses. The type of PICC we use is the solo power picc. The radiologist want it for better visualization of the tip. Will leave it in for the larger patient, but not for others. It is difficult to have the rad techs available when the picc is finished and it can take over 20 minutes to obtain results.
Carol Busch
Carol Busch RN,VA-BC, CPUI
PICC/Vascular Access Nurse