Title: Pre-Printed documentation Sheets or Stickers
We have our documentation record available from any computer via our intranet.  We print this form on the patient's unit for our documentation.  We have check boxes to complete the documentation.
This record includes much of the same information that you have, but in addition, we have that the consent was given, the patient is a candidate (if not that we referred to the ordering physician or to interventional radiology), that we did review their pre-insertion lab values, brand of catheter (may be the same as the type of PICC for you), sterile procedure used with maximum barrier precautions, location of arm circumference, local anesthesia includes a choice of lidocaine 1% (no reference to the amount included) and LMX4 (with length of time intact on skin), any difficulties occurring during insertion (bruising/hematoma, difficulty advancing, unable to advance past ___cm., referred to Interventional Radiology, PICC tip location (obviously after chest xray), section for action taken after chest xray if tip location not SVC and dressing section has securement selection (for StatLock or steri-strips, which we rarely use for securement).
I don't know what the orange band is that you listed.
 
Gwen Irwin
Austin, Texas
----- Original Message -----
Sent: Friday, November 11, 2005 8:20 AM
Subject: Pre-Printed documentation Sheets or Stickers

Does anyone use pre printed documentation sheets or stickers using the format a check-ff list format for insertion of PICC/Midlines. 

The nurses on our IV team want to use the sticker below to replace most of the required documentation.
What are your thoughts?
What would JCAHO think?

Type of PICC
Gauge
Lot#
Expiration
Total Length of Cath
External Length
Number of Lumens
Type of PICC
Vein Basilic /Cephalic/other
Arm Circumference
Site Rite
Mirco-introducer
Lidocaine 1% 0.1-0.33mL
PICC flushed/Blood return
Dressing applied
Orange band intact
Clamps given
Teaching booklet given
Chest x-ray ordered
Patient tolerated procedure
Signature
Title/date/time

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