I recently started a new job as a PICC Nurse (was a Vascular Access Specialist for 10+ years under Nursing) in Special Procedures. The policies are very different compared to what I am used to. If you have references to answer my questions, please include.
1. Pt has a set of cultures drawn (not for suspected line infection). Must wait 48 hours before placing PICC, but a physician can place other central access.
2. Do you hold PICC placement if Lovenox is given? Friday had to wait to place PICC for 24 hours because pt got Lovenox 80mg at 0200. Which means since we are not here on the weekend, no PICC til Monday. Coags were normal. (This is one radiologists rule).
3. Do you hold placing a PICC for any elevated INR? Policy here states contraindicated if INR >2.5 and Platelets <50
4. Contraindicated in pts who crutch walk.
5. Short peripheral IV's get changed every 72 hours (trust me, I've been to the CNO already about this)
I am in the process of bringing mid lines back into this hospital. I feel helpless and that we are doing a dis service to the patients allowing them to get stuck so much. Any advice would be greatly appreciated!
Melanie Heisner RN-BC, CRNI
1. no evidence found for this in 2016 INS Standards
2. No reason for this and no evidence to support, also not in INS SOP
3. Same, no reason, no evidence
4. this one is valid, pressure in axilla can increase risk of thrombosis
5. very old practice as you already know. See INS SOP on VAD Removal for references
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