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ASSESSMENT OF
THE TIP OF A PICC
You need to
evaluate a PICC prior to using the line. The following information is
essential in making a thorough assessment.
BASELINE
MEASUREMENTS:
-External catheter length immediately after insertion.
-Initial chest Xray results
Relationship of
the baseline measurements will illustrate movement of the tip following
insertion. Without this information a proper assessment of the tip is
impossible without a new chest Xray.
ARMBAND WITH
BASELINE MEASUREMENTS
If the PICC line
is placed at Sinai by the Vascular Access Nurse, there will be an armband
making this vital information readily available to the line user. The
armband should be placed on the same limb as the PICC line is placed. It
should not be removed until the line is removed.
WHAT CAN BE
DONE IF THE INFORMATION IS NOT AVAILABLE TO THE LINE USER?
If you are in
doubt about where the tip is get a chest Xray to verify its location. DO NOT
ASSUME THAT A LINE CALLED A “PICC” IS TRULY A PICC. Midlines are often
“generically” called PICC lines. The PICC/midline may be used for blood
draws and SHOULD be flushed routinely to maintain patency regardless of
where the tip is. NEVER administer IV fluids or medication until you know
where the tip is located. |
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WHY IS THE
LOCATION OF THE TIP IMPORTANT?
You must have SVC or SVC/RA tip placement of a PICC to
administer TPN. The risk of thrombus is high if the tip is left in the
subclavian or the jugular. The risk of cardiac arrhythmias is high if the
tip is left in the right atrium. According to the Nurse Practice Act in
Maryland,
a PICC should not be used if the tip is not located in the SVC or SVC/RA.
Subclavian placement is acceptable only with written doctors order.
Vancomycin, Nafcillin, chemotherapeutic medications, and other
irritant/vesicant solutions should not be administered via a midline
catheter since the tip of the midline is in the axilla.
ONCE YOU HAVE SVC OR SVC/RA TIP PLACEMENT YOU MUST
ASSESS THE LINE FOR ANY POSITION CHANGES AND CARE FOR THE LINE
ACCORDINGLY. BE SURE TO DOCUMENT THESE ASSESSMENTS.
VASCULAR ACCESS
DATABASE OF PICC LINE INFORMATION
The Vascular
Access Nurse at Sinai keeps a database of all the lines they place. If a
patient has a line placed by the Sinai VAN they can locate the baseline
information for you. HOWEVER, if they are not available ONLY via chest Xray
can you be sure you are safe to use a PICC/midline. Don’t take chances.
Know where the tip of you PICC/midline catheter is located BEFORE you
use it to administer IV fluids/medications.
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