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“PICCs are just
like all other central lines.”
The fact is this
is NOT true. The things PICCs have in common with central lines are the
placement of the tip and the flushes and dressing changes. The PICC is a
unique catheter. It is more delicate, has smaller lumens and much longer
than other central lines so it can not withstand the pressure and high
volume infusions a central line can handle. The PICC passes through veins in
the upper arm that have valves, which tend to spasm when stimulated. These
spasms can cause discomfort, sterile phlebitis (irritated vein wall), and
catheter embolus (pieces of the catheter in the bloodstream) if the line is
pulled out too fast during a spasm. If the patient experiences discomfort or
tenderness along the vein path warm, wet compresses are often very helpful
in relaxing the spasms and decreasing the discomfort. The compresses may
need to be used continuously for a few days to see improvement in the
symptoms. Without treatment, the PICC will often have to be removed.
“After drawing
blood, hooking up the IV will flush the blood out of the PICC and back into
the patient.”
NO, NO, NO!
Manual flushing is ALWAYS necessary to clear the PICC line
efficiently and prevent clogging the lumen. IV rates are often too slow to
effectively flush the line and prevent fibrin from building up on the
catheter’s internal lumen. NEVER draw blood from a PICC without IMMEDIATE
manual flushing of the line after the blood is drawn.
“Having a PICC/midline
placed is just like having an IV started.”
This is
something that the patients are often told prior to having a PICC placed.
This is not true. PICC/midlines
are placed using a sterile procedure, including wearing a gown, sterile
gloves and a mask. If the patient goes into this procedure thinking that
getting a PICC/midline is like having an IV started, donning the sterile
gear will only frighten them. Also, measuring their arms from antecubital to
their neck is done to get measurements for the length of |
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the catheter
length prior to placing a PICC. This really scares a patient if they believe
getting a PICC is like having an IV started. They often think it is going
into their throat. The patient should be told prior to signing the consent
that the line is placed with a sterile procedure that could take about 45
minutes to an hour. Most of this time spent setting up for the procedure.
Also, if they are to receive a PICC, they should understand that the tip of
the catheter will reside in their SVC and that the midline tip will reside
in the axilla area. PICC/midline placement is
nothing like having an IV
started.
FACTS:
·
PICC/midline catheter material is more
delicate than a central line. That is why they can stay in the vein
longer. They are more “vein friendly”.
·
A pulsation flush done manually with a
10ml syringe after drawing blood is the ONLY way to thoroughly
flush a PICC/midline to decrease fibrin build up and maintain catheter
patency.
·
PICC/midline catheters are NOT easy to place.
They are inserted under sterile conditions and take about an hour to
place.
·
PICC/midlines are not the line of choice when
a patient receives high volume infusions, high pressure injections and
therapy lasting only a few days.
·
PICC lines should be placed in patients who
will receive IV therapy for greater than a few days and/or receive
medications that are best infused through a central vein.
·
Midlines are used for shorter term IV therapy
(1-4 weeks) to infuse medications can be safely and comfortably infused
through a peripheral vein.
·
Midlines are not reliable for blood draws.
·
PICC lines should not be placed until the
appropriate medication and length of therapy is determined.
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