Is there a contraindication in placing a PICC on a pt who is currently receiving multiple chemo infusions?
Pt was started on chemo infusion via PIV. PICC was ordered but PICC insertion was refused by one of the nurses in our Vascular Access Team in fear of exposure to chemo agents. She then informed the physician that she can only place the PICC after chemo is no longer in patient's system, usually after 48 hours (?). The other oncology nurses in the floor support this idea as well.
After I asked other vascular access specialist and experts, also checked INS, and I found no reason to hold the PICC, I immediately placed the PICC line against the other PICC nurse warning about chemo exposure. Now, our team is divided on the issue and would like to bring it up to management, their concern being putting the inserter at risk and that those whom I asked were vascular access experts not oncology nurses or experts.
Do you have any evidence I can use for discussion?
I think your fear is not supported by evidence. Yes, there is a need to protect oneself from blood and body fluids for ALL patients receiving any form of chemotherapy. This extends to urine as well as blood. So are we going to tell patients we can not help them with toileting just because they are receiving chemotherapy? I would also agree that the vascular access should have been planned in a better manner before the chemo started. But just because chemo was already infusing, I do not think that is a valid basis for refusing to place a PICC. You can protect your self before, during, and after the procedure. The one person that should not be doing this procedure woukld be a pregnant nurse. 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
One rebuttal I was told is that the sterile gloves we use (we double-glove) is not for chemotherapy (not chemo-tested). I was told that chemo-tested gloves are used when handling body secretions. Is double-gloving sufficient or do I need to use a non-sterile chemo-tested glove under my sterile gloves?
Thank you Lynn!
You would need to use the gloves that meets the standard for coming into contact with all blood and body fluids in patients receiving chemo. The same gloves used to administer chemo, in a sterile package woukd be needed. ONS has lots of resources on this issue. 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