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