Catheters are cleared for market, not approved, by the FDA as either
less than 30 days or more than 30 days. No manufacturer can or should
make a claim about recommended dwell time because they do not have
knowledge of the patients condition. The 12 months that Lee referred
to came from the INS position statement on PICCs written many years
ago and drawn from the work done by the INS PICC Task Force in the
mid 90's. The original statement was that PICCs were indicated for
therapies of up to 12 months. This is quite different from a
recommended dwell of 12 months. Two completely different things. Lynn
At 9:54 AM -0700 12/29/05, Kokotis, Kathy wrote:
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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