Does anyone know of any data / research regarding the practice of placing a peripheral short IV catheter in the same extremity where a PICC line has already been placed for multiple IV access needs? I say it is not good practice but am having difficulty passing the word and helping fellow nurses understand the danger of increased infection possibility and safety issues for the patient.
A PIV in the same arm as a PICC would not be an absolute contraindication, as in never do it under any circumstances. It would be a relative contraindication as in make a careful patient assessment each time this is contemplated and avoid it if possible. It should not be a routine practice. First, a careful assessment of VA needs should have indicated the need for a double lumen PICC, eliminating the need for a PIV. Second, I would not associate infection with as the risk here. It would be vein thrombosis. An injury to a peripheral vein with or without clinical signs of phlebitis can easily propogate to the entrance for a PICC, thus extending the superficial thrombophlebitis to the area of the PICC insesrtion. This would be superficial vein thrombosis, but superfical veins are connected to deep veins thru perforating veins. So thrombus can grow from a superficial vein into a deep vein. The actual occurrence rate of this has not been documented to my knowledge. Based on anatomy and physiology of the tunica intima and thrmobus development, it is quite possible. Based on this, I would say a PIV should only be placed in the same extremity as a PICC when there is no other alternative and then it should be as distal to the PICC as possible. 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