Hi everyone!
There is a difference of opinions right now between a consulting physician (pulmonologist) and a CCU RN regarding using the right arm (PICC arm) wrist area for ABGs as we cannot use the left arm due to h/o mastectomy. I've been taught by my mentor that we can use the wrist of a PICC arm for ABGs or even venipuncture. The problem is my mentor for PICC insertion doesn't work with me anymore and I cannot reach her at this time for input.
The CCU RN insists that per policy the PICC arm cannot be used for IVs, venipuncture, BPs and therefore we cannot use the arm for ABGs also. My argument (and the pulmonologist as well) is that the PICC is in the upper arm and therefore will not be inadvertently punctured for the ABG. The MD now wants proof or policy that we CANNOT use the arm with PICC for ABGs.
Is there any reference that we can use to write a policy that will allow us to use PICC arm (wrist area) for blood draws or ABGs?
The nurses here are bugging me for references, so I'm asking for your help!!!
Thank you in advance for all your responses!
There is nothing in the Infusion Nursing Standards of Practice that would prohibit the use of the radial artery for puncture in the same arm as a PICC. As you stated, these sites are separated and there is no danger of damaging the PICC with this arterial puncture at such a distance location. With that being said, any invasive procedure in an arm with an existing VAD could produce a problem. I am thinking of altered circulation due to thrombosis from the presence of the PICC making arterial puncture difficult. It would require severely impaired venous return in the arm with the PICC and it is possible from this venous congestion to compromise arterial flow on the same extremity. Any additional puncture site adds greater insult to that extremity. It would all come down to a matter of weighing the risk vs the benefits of using this arm for arterial puncture. What is the condition of the arm with the PICC? Is there lymphedema in the opposite arm? Was there node dissection or a simple mastectomy? All of these would be factors to consider. I am not aware of any published studies on outcomes with such as situation. And I do not believe that we will ever have studies to answer every clinical question such as this. So it is a matter of assessing all the risks and benefits and choosing the intervention with the best benefit and least risk. You do need to be practicing within your established policies however. So if the CCU RN is correct about what your policy states, then you can not alter that policy for a particular patient. it must go through the proper committees to make the necessary changes in that policy statement. if indeed this has been written as a policy statement, then your hands are tied and you can not make this arterial puncture without those committee changes. Policies should be regarded as non-modifiable and nonnegotiable rules of your organization. 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