We are looking for information about what are thoughts and/or feedback on 2 areas of concern regarding PICC and pacemakers:
1) if a patient has a new permanent pacemaker, how many months should a bedside PICC placement be avoided which would require the PICC to be placed under fluoroscopy by Interventional Radiology?
2) If you have a patient with a new permanent pacemaker and had a PICC in place prior to this, and then the PICC needs to be removed for whatever the reason, who should do this and should it be done under fluoroscopy?
In our facility we don't place bedside PICCs on patients with Pacemakers less than 6 months old, they usually go to Iinterventional Radiology... But this rare because most of our pacemaker patients have had their pacemakers over 6 months. But recently we now have 2 cases that deal with the concerns noted above....
Looking to upgrade our policies with evidence based practice guidelines if this is possible. Still looking for studies or literature on this topic.
Tracy Ivory, RN,CRNI,BSN
Faxton-St. Luke's Healthcare
There is no evidence to base an answer to your questions. The PICC insertion procedure is probably not the greatest risk, so I am not so sure if IR would be any better than bedside. The risk is probably more associated with removal of the PICC. If a thrombosis has bridged between the CVAD and pacemaker, removal of the CVAD could fracture the pacer wire or displace it. Removal under fluoroscopy may be a good idea although I don't think it is common practice. Lynn Hadaway Associates has an online CE course on CVADs and pacemakers. We thoroughly combed the literature for all that is published about this and there are no many studies at all. What is known is in this course. 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