I also 100% disagree! Dianne Sim IV Assist, Inc Pinole,CA -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway Sent: Monday, January 30, 2006 2:23 PM To: Kokotis, Kathy; Bev and Tim Royer; CAROLYN; [EMAIL PROTECTED] Subject: RE: INS standard # 37
I strongly disagree and think you are off on another tangent! Lynn At 3:06 PM -0700 1/30/06, Kokotis, Kathy wrote: >I am beginning to believe all PICC lines should be placed in >radiology where there are: > >PICC, Stick and Run teams > >PICC lines placed with traditional peel-aways > >PICC lines placed without Ultrasound > >Radiology does it safer in those instances > >If I were the patient in any of the above I opt for the radiology >placed PICC line > >Kathy > >________________________________ > >From: Lynn Hadaway [mailto:[EMAIL PROTECTED] >Sent: Mon 1/30/2006 1:23 PM >To: Kokotis, Kathy; Bev and Tim Royer; CAROLYN; [EMAIL PROTECTED] >Subject: RE: INS standard # 37 > > > >Well Kathy, I think that you are still comparing apples and oranges >when you compare IR inserted PICCs to a nurse-inserted service. I >think you are comparing data from multiple studies without going >through the strict analysis processes required for a meta-analysis. > >When we were looking at the published data for the standards, I nor >anyone else on the INS standards committee found an article of any >kind comparing PICCs inserted with the standard through the >introducer to PICCs inserted using MST. You may claim that you can >compare data from multiple studies but until it has gone through a >true meta-analysis process and the peer-reviewed publications >process, it can not be used as a reference in a document such as the >standards. > >I really do not think anyone is arguing that the AC inserted PICCs >are better than the ones placed above the AC, so I think we are >making a mountain out of a mole hill on this one! Lynn > >At 11:54 AM -0700 1/30/06, Kokotis, Kathy wrote: >>I do not know if anyone read my last paper in the LITE spectrum but >>I did address the two papers with looking at complications rates of >>MST & US and upper arm placement vs nursing traditional insertions. >>How did I do this. IR used upper arm and MST and ultrasound and >>nursing used traditional tools. Phlebitis rates, thrombosis rates >>were higher for nurisng group significantly. >> >>If INS does not understand to this day that upper arm basilic >>placement has a lower rate of complications and that usage of >>portable ultrasound is highly recommended and evidence based in the >>AHRQ government safety report than how can I defend practice that is >>so out of date. I can defend what we do not easily as INS is not >>reading the literature >> >>My soap box is over. Get with the times. By the way from my >>figures 45% of PICC lines are placed in nursing with MST and 100% in >>radiology with MST. You do the math. The doctors are right and >>more patient focused. Ultrasound is used 15% in nurisng insertions >>and doctors use fluoro or ultrasound in 100% of cases. I don't know >>about INS but standard of care dictates the usage of US or MST or >>all PICC lines should be send to radiology to be placed. What do >>you think of that one? >>kathy >> >>________________________________ >> >>From: [EMAIL PROTECTED] on behalf of Bev and Tim Royer >>Sent: Sun 1/29/2006 10:02 AM >>To: 'CAROLYN'; [EMAIL PROTECTED] >>Subject: RE: INS standard # 37 >> >> >>When looking at this standard it is important to note that >>Paragraphs II & III A and B which come before paragraph C state: >>A "Site selection criteria should be established in >>organizational policies and procedures and practice guidelines." >>B "Site selection should be determined per manufacturer's labeled >>uses(s) and directions for device insertions." >> >>To me, as a clinician, I am covered under paragraphs A & B if >>placing in the upper arm using ultrasound imaging. >> >>Currently there is very little scientific evidence based practice >>published on the topic of comparing antecubital and upper placement >>of PICCs. Most manuscripts, address increase in successful PICC >>line placement rates in the upper arm using micro-introducer and > >ultrasound imaging technology. Only antedotally is it mentioned >>that there is a decrease in mechanical phlebitis and an increase in >>patient and nursing satisfaction not having the PICC placed in the >>region around the antecubital fossa. >> >>The use of micro-introducers and ultrasound imaging with nursing is >>still only a small percent of the total number of PICCs placed by >>nursing. There are many facilities and agencies that place PICCs >>using the traditional approach of sight and feel and place in the >>antecubital fossa regional and report that they have good outcomes. >>Nurses are good at what they do. >> >>Antedotal evidence is OK and is considered but it is not considered >>rigorous scientific study. Outcome data analysis carries a little >>more weight and should be published more than it is in this area. >>However, like everybody else in our field, our time is so involved >>in patient care and management that publishing is low on our >>priority list. Best would be research in this area involving a more >>rigorous scientific study comparing both areas of placement >>(antecubital fossa vs upper arm). Again our time is limited at work >>and the time involved in getting an approved study through the IRB >>at the facilities we work at and the time necessary to carry out the >>study is very involved and time consuming. Nursing Research is not >>a high priority for many institutions. >> >>We all need to be tracking our data on PICCs and complications and >>have the data published. >> >>Bottom line here - "The Infusion Nursing Standards of Practice", >>revised 2006 edition, cannot put a standard in that is not backed up >>by rigorous scientific study even though antedotally we see better >>outcomes. It has been published over and over again that nurses can >>place PICC lines safely in the antecubital fossa region. >> >>Timothy Royer, BSN, CRNI >>Nurse Manager / Vascular Access / Diagnostic Service >>VA Puget Sound Health Care System >>Seattle / Tacoma, WA >> >>Disclaimer - This are my personal beliefs and do not represent the >>institution I work at. >> >>________________________________ >> >>From: [EMAIL PROTECTED] >>[mailto:[EMAIL PROTECTED] On Behalf Of CAROLYN >>Sent: Sunday, January 29, 2006 7:40 AM >>To: [EMAIL PROTECTED] >>Subject: INS standard # 37 >> >> >># 37 Site Selection - Practice Criteria: II Peripheral-Midline and >>III PICC it states: >> >>Site selection should be routinely initiated in the region of the >>antecubital fossa; veins that should be considered for cannulation >>are the basilic, median cubital, cephalic, and the brachial. >> >>When we use ultrasound we are hardly ever placed in the antecubital >>fossa because of the larger catheters being required, increase in >>antecubital complications because of movement and of course patient >>comfort. >> >>What are the legal implications of this in court by not using the >>antecubital for placement? Thanks >> >>Upgrade Your Email - Click here! >><; partner=hbtools> >> > > >-- >Lynn Hadaway, M.Ed., RNC, CRNI >Lynn Hadaway Associates, Inc. >126 Main Street, PO Box 10 >Milner, GA 30257 >http://www.hadawayassociates.com >office 770-358-7861 -- Lynn Hadaway, M.Ed., RNC, CRNI Lynn Hadaway Associates, Inc. 126 Main Street, PO Box 10 Milner, GA 30257 http://www.hadawayassociates.com office 770-358-7861
