At times when I know jprior to placing PICC Line that pt has poor visualability on their lung field would make it difficult for the PICC Line tip to be viewed. I will leave the stylet in the lumen for the Xray to facilitate radiology view PICC tip. Once Xray is resulted, I place an order for the stylet to be removed and clave placed on lumen.
Doing this has raised some concern, does anyone else do this at times? I usually only do this when the pt can't go be moved to xray dept for a two view.
Debra
Long Beach Memorial
This is an old technique and the way I practiced for many years on every PICC. However, you said one thing that is extremely troubling. This procedure must be completed by the inserter. You can not and should not delegate this stylet wire removal to another nurse. What happens when the catheter is not properly located? Those staff nurses can not be the ones to manipulate it into place. The external catheter can never touch the skin if you need to do any manipulation. Once the catheter has touched the skin, it can not be withdrawn and readvanced. Skin can never be rendered sterile regardless of how well it is prepped. So that external component must be encased in sterile gauze. The catheter and arm must be wrapped with a sterile dressing like Kling or Kerlix however this will only provide a minimal amount of stabilization during the xray. Now with ECG, this technique is not necessary as you can know exactly where the tip is, an eliminate the chest xray in 75 to 90% of patients. If you continue this practice, it is the responsibility of the inserter to finish the complete procedure, remove wire, document tip location and entire procedure, stablize the catheter and dress it. 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
Good points Lynn. Our hospital is not wanting to upgrade to ECG. In addition they are eliminating VAT (after many many years) and using registry. The reason I left the removal to the bedside nurse is that it was end of my shift and NO OVERTIME! I do add instructions if malpositioned, to Not Use and VAT will follow up in AM.
I intend to keep practicing and will keep in mind the additional steps I could take to ensure sterility.
As always Thank You
Debra
Debra Rivie RN VA-BC
Long Beach Memorial Medical Center
Long Beach, CA
I can understand your dilemma about overtime, but the COMPLETE insertion is your liability. So you would be held accountable for everything done by someone else. Not a position I would like to be in! 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
Lynn is correct, that used to be an old way when viewing the film was difficult you would leave the wire in and xray. However, You still were responsible. You really shouldn't leave that wire for a staff nurse. Our rule at PENN used to be, it is your line and your responsible until it's dispositioned. So, leaving and not finishing it out....I would not feel comfortable doing that.
Jack
This discussion should be useful to our peers in mobile vascular access. Often it takes a while for the xray tech to arrive at the facility. Even with digital xray the wait for an image can be quite long. Some mobile providers expect the inserting clinician to get on to the next line, allowing facility staff to manage the remaining components of placement. Hopefully this discussion will help those clinicians have courage to own their lines and stay to the end.
Agreed, Never considered the Mobile folks...I would have to agree with Jill though...they must stay with the line in that situation. If anything bad happens, it won't go nice for the inserter.
Jack
I have done this on rare occurences on very obese patients who were not ECG candidates. Each time the xray machine was brought into the room and draped with sterile drape prior to the shot. Once the shot was successfully obtained I then removed the stylet and placed the needleless connector myself prior to breaking down the sterile field. I do not feel comfortable leaving the bedside nurse with this task.
Danielle McClain RN, BSN
Debra,
We used to run into this before ECG was available. We handeld it differently depending on the patient and his or her blood vessel size, planned therapy, allergies, hyrdration status and a close look at renal function. The stylet was helpful a little but not greatly, we would obtain orders for an injection of contrast media at the time of the portable chest x ray. The filling volume for a picc is very very small. The radiogist or attending would usually give the order and the Radiology Technologist would administer the contrast. Additionally the Rdaiology Technologist would angle the patient 45 degress RPO ( right patient origin), this moves the view of the catheter away from the edge of the spine and really aids in visualiztion. If your state requires consent for contrast media your Radiology Technologist can handle it. Seems like a lot but it is better than 2,3 or 4 x rays while the patient waits for therapy initiation. One last measure is upsizing toa 5 fr cath, although it not a large jump in size it shows up much better on imaging. I never liked that alternative at all and only emplyed it under extreme situations.
Tim
Tim Youngmann RN