I agree with Tony
There is no time limit on a PICC from the FDA as it is approved for marketing /
distribution ( I hope I said that right) in the over 30 day dwell category.
All companies now have this approval for long term dwell which was not true in
the past.
I caution usage of the EJ for the following reasons. It is a small vessel, it
is torturous, and probably has a high rate of thrombosis as a result. I am not
a fan of using the EJ for PICC lines and think we should pursue the IJ. Yes I
said the IJ which is large and direct. We need to petition for the IJ and not
the EJ if the patient is our best interest. That is my soapbox of the day.
Kathy
________________________________
From: [EMAIL PROTECTED] on behalf of [EMAIL PROTECTED]
Sent: Wed 12/28/2005 2:07 PM
To: [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
Subject: Re: question for the group: Neck placements of PICC Lines
I am not sure where your 12 month limit for PICCs is coming from. FDA
classifies catheters as extended dwell (greater than 30 days) or short term. So
as long as a PICC is free from complications it may stay in place. This could
change in a month if the INS decided to put some limit on PICC dwell times in
the new standards due out in January 2006. I can hardly wait for the
discussions over any changes they did make. Should be fun times on the list.
As far as warranties I would check the DFUs. You get very little no matter
where you put the line. I was very concerned when people first started using
the EJ. My question was is the neck a "peripheral" site. Or were we crossing
over into the realm of a medical act. I think that question has been answered
now and it is peripheral. So an EJ PICC should fit the definition of a PICC.
I also agree that are we now presented with a variety of insertion sites and
vessels. No longer is a PICC always found in the AC. It is perhaps time to form
new best practices by defining PICC's a little more as we discuss Insertion
locations, vessels and techniques can all carry unique factors in our
assessments and decisions.
Tony West, RN, CRNI
Healix, Inc.
Email: [EMAIL PROTECTED] or [EMAIL PROTECTED]
SMS: [EMAIL PROTECTED]
Cell: 214-674-4848
In a message dated 12/27/2005 8:54:13 A.M. Central Standard Time, [EMAIL
PROTECTED] writes:
A PICC inserted through the arm has a dwell time of 12 months that can
be extended. What would be the dwell time of a "PICC" inserted into the
external jugular?
If manufacturers design PICCs for arm insertion, are warranties etc the
same? Or is it considered "off label" use?
I agree with Martha that it does indeed cause GREAT confusion regarding
care & maintenance of that catheter when patients with these catheters are sent
out to alternate sites such as nursing homes.
Lee in CT
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of
Martha Pike
Sent: Friday, December 23, 2005 10:29 AM
To: [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
Subject: Re: question for the group: Neck placements of PICC
Lines
Again - a plea to always use terminology that clearly
identifies where the line is located as well as whether it has a central or
peripheral tip location.
The distinction re whether this device went in through the
internal or external jugular influences the comparative risks during the
insertion procedure, but is of little consequence in terms of caring for the
catheter afterward. If both are threaded to the SVC, both are central lines. If
both are inserted in the neck, then there are the same problems / issues with
nursing care.
However, the difference between an antecubital or upper arm
insertion and an insertion in the neck is of great consequence in terms of
caring for the catheter and making sure that all nurses in all subsequent post
hospital care situations understand what kind of admission they are accepting
so that they can ensure that the patient receives competent and safe care.
PICC is a term that has been well understood for almost 30
years to be a device that is inserted through the arm. To call an external
jugular device a PICC without identifying the point of entry creates great
confusion.
My personal preference would be to call it a jugular CVC as
that is how it will be cared for. However, if we need to call it a PICC to make
it clear to Boards of Nursing that it is OK for a nurse to insert, I don't
object as long as we say - consistently every time we discuss it or document
care - that it's a jugular PICC.
/Martha - Boston
On Dec 22, 2005, at 10:20 PM, MidWest Vascular Access wrote:
If the tip of an intravenous catheter resides in the
SVC or IVC, then it is a central catheter. But, the site of insertion should
determine whether it is referred to as a Peripherally Inserted Central Catheter
or a Centrally Inserted Central Catheter (tunneled lines, implanted ports,
percutaneous triple lumens, dialysis catheters). I have been trained for years
that a line that originates in the neck or chest is a centrally placed central
catheter. A line that starts in the arm, or legs of peds patients, is a PICC.
If a line manufactured to be a PICC is placed anywhere
but the arms or legs, it is still a central line (if in the vena cava), but
should no longer be called a PICC, rather a percutaneous central catheter.
Please correct me if I am wrong!!!!!!!!!
Michelle Followell, RN, CNN, CRNI
-----Original Message-----
From: Fritz, Donna [mailto:[EMAIL PROTECTED]
Sent: Thursday, December 22, 2005 2:49 PM
To: Betsy Harmon; MidWest Vascular Access; Mullins,
Lilia; [EMAIL PROTECTED]
Subject: RE: question for the group: Neck placements of
PICC Lines
Isn't tip termination inherent in the definition of a
central venous catheter?
Donna Fritz
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL
PROTECTED] Behalf Of Betsy Harmon
Sent: Thursday, December 22, 2005 11:41 AM
To: MidWest Vascular Access; 'Mullins, Lilia';
[EMAIL PROTECTED]
Subject: Re: question for the group: Neck
placements of PICC Lines
CDC made the distinction that the EJ is
peripheral and the IJ is Central.
Betsy Harmon RN BSN CRNI
----- Original Message -----
From: MidWest Vascular Access
<mailto:[EMAIL PROTECTED]>
To: 'Mullins, Lilia' <mailto:[EMAIL
PROTECTED]> ; 'Betsy Harmon' <mailto:[EMAIL PROTECTED]> ; [EMAIL PROTECTED]
<mailto:[EMAIL PROTECTED]>
Sent: Wednesday, December 21, 2005 4:59
PM
Subject: RE: question for the group:
Neck placements of PICC Lines
A PICC placed in the neck... well, is
not a PICC, but a percutaneous central line that is not peripherally placed.
Am I right?
-----Original Message-----
From: [EMAIL PROTECTED] <mailto:[EMAIL
PROTECTED]> [mailto:[EMAIL PROTECTED] On Behalf Of Mullins, Lilia
Sent: Wednesday, December 21, 2005 1:31
PM
To: Betsy Harmon; [EMAIL PROTECTED]
<mailto:[EMAIL PROTECTED]>
Subject: RE: question for the group:
Neck placements of PICC Lines
Please share with the group, what about
Nurse Practice statements?
Thanks in advance
Lilia Mullins, RN, CRNI
Swedish Medical Center
Seattle, WA
________________________________
From: [EMAIL PROTECTED] [mailto:[EMAIL
PROTECTED] On Behalf Of Betsy Harmon
Sent: Wednesday, December 21, 2005
10:26 AM
To: [EMAIL PROTECTED]
Subject: question for the group: Neck
placements of PICC Lines
I have heard that some of the PICC
Inserters out there are placing PICC's in the EJ. If so would you be willing
to share what type of documentation your facility requires for that placement.
Is there any competencies required? Do you have to document educational
experience for placing PICC's in the neck. Anything you have would be
appreciated. Please e-mail me with any info.
Thanks in advance.
Betsy Harmon RN BSN CRNI
Vascular Access Team
Critical Care Unit
Alaska Native Medical Center
Anchorage, Alaska 99508
[EMAIL PROTECTED]
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