RE: RE: question for the group: Neck placements of PICC Lines

Nancy Moureau Thu, 29 Dec 2005 10:08:35 -0800

Title: Message

No apology needed, Lee. The 1 year, 12 months for a PICC came from the INS Standards of 1998. The 2000 INS Standards dropped the length of time allowing more consistency with CDC guidelines that state optimal dwell time is unknown.

Nancy Moureau, BSN, CRNI

PICC Excellence, Inc.

888-714-1951

www.piccexcellence.com

[EMAIL PROTECTED]

-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Toth, Lee A.
Sent: Thursday, December 29, 2005 12:29 PM
To: 'Kokotis, Kathy'; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
Subject: [Norton AntiSpam] RE: question for the group: Neck placements of PICC Lines

I apologize. I don't know where I got the 12 month...could be extended from. I thought it was from an INS position paper, but I can't find it. There was no objection to the placement....just how it is described. From long term care pharmacy perspective, using "PICC" to describe a PICC in the EJ is confusing. Consider this discussion and the expertise of the folks on this list.

"Jugular PICC" would be okay if it were consistent and we can work on the education.

BTW, what is the experience of those placing PICCs in the EJ regarding complications and the dwell time?

Thanks.
Lee

-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]]On Behalf Of Kokotis, Kathy
Sent: Thursday, December 29, 2005 11:55 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
Subject: RE: question for the group: Neck placements of PICC Lines

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]]On 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]]On 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

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RE: RE: question for the group: Neck placements of PICC Lines

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