Hi, I am expanding into outpatient PICC placement in our rural community. I plan on using the following form for my order sheets. Please share your EXPERTISE.
thanks in advance! other outpatient reasons for PICC? I will of course do the standard assessment at arrival etc.
Patient Information Reason for line: Frequent blood sampling Chemotherapy Outpatient Infusion of hyperosmolar solutions (TPN) Outpatient antibiotics Difficult PIV access Blood infusion X Current (within 30 days) labs faxed I review WBC, Creatine, H&H, INR, PLT, CXR, GFR, EKG, PMH, Allergies, and document on the back of the order form that I complete (if availiable)
PATIENT NAME: _____________________________________________________ DOB: ___________________
1. Request Vascular Access Team (VAT) to place PICC for (check all that apply):
□ Home infusion □ Chemotherapy
□ Long Term IV therapy □TPN
□ Irritating/Vesicant drug therapy □ Frequent lab draws
2. Lumens: □ SINGLE □ DUAL
3. Use ultrasound guidance for vessel access
4. Fluoroscopy may be utilized for insertion, reposition or exchange.
5. Obtain CXR after insertion/reposition/catheter exchange to determine distal tip location
6. PICC may be used once tip is determined to be in the distal Superior Vena Cava (SVC) or at the junction of the SVC/Right Atrium (RA) - also known as the CavoAtrial Junction (CAJ).
7. Medication Order: _________________________________________________________________________
8. Patient may be discharged once PICC has been placed and placement confirmed (and after initial medication dose administered with appropriate monitoring for adverse reaction as applicable).
9. Care and maintenance per standard/protocol of homecare/infusion company.
List homecare/infusion company: ______________________________________________________________
Physician Signature: _________________________________ Date: ______ Time: ______
Physician Name (Printed): ____________________________________________________
Keely Ralston RN-BC, VA-BC, CPUI, RCIS
What reasons would we need a dual lumen on an outpatient basis? I just want to have it clear in my head from a more experienced infusion nurse.
thanks in advance!
David
I have a comment about these forms and how they are used. I would not be comfortable allowing the LIP (MD, NP, PA) prescribing the CVAD to indicate the number of lumens they want. Am I understanding how these forms are used? I would regard this decision as being part of the total patient assessment. This complete assessment would include site assessment for the best vein and side of insertion; medical history, allergies, vasovagal reactions, indications for CVAD, contraindications; all pertinent lab data and vital signs; and catheter assessment for size, length and number of lumens. The type(s) and number(s) of therapies will dictate the number of lumens needed and the prescriber may not have the knowledge of infusion techniques needed to make this decision, thus I would not put this decision in their hands. It would remain a decision for the inserter/operator. Another reason why vascular access and infusion therapy can not be separated. 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
thanks Keely. I agree Lynn. I have the doctors order a PICC consult and request number of lumens but if I disagree after my assessment I call them and discuss it with them. Great point. I have really benifited from your push to encompass Vascular access team not just PICC RN. In the future I now want to get my CRNI as a result. Any and all suggestion really do help to make us better as a professional. :)
thanks!!!
David
Oncology chemo plus need for fluids, antibiotics. TPN plus any other meds. Just two common examples. 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