Re: Midclavicular catheters

[VICTORIA SALLESE]

A lot of the LTF here in Maryland want a hard copy of the PICC placement xray, not just the reading. A lot will not accept PIV's, they want the hohns, or Hickmans or PICC in place, centrally located  before they are transferred. Now, I do not place lines in LTF's, so once one of their pts. needs IV's & did not arrive with access, I do not know what they do.

Victoria Sallese
VAT
Johns Hopkins Hospital

----- Original Message -----

From: [EMAIL PROTECTED]

Date: Thursday, March 16, 2006 7:30 am

Subject: Re: Midclavicular catheters

> Here we go again discussing LTC patients.  The reality is that not
> accepting the patient is not an option for any LTC facility.  If
> they refuse a patient, they can seriously damage the relationship
> with the referral source, and they cannot afford to do that, they
> need every patient they can get. Also, most admissions people at
> LTC facilities are NOT nurses, so they have NO idea what a PIC or
> PICC is, or where it should be. It is a rare facility that gets
> the DON or other nurse involved in the admissions process.  So,
> most of the time (99%) the staff nurses have to work with what
> they get when it arrives, and the hospitals are VERY difficult to
> work with to get any information out of once the patient is at the
> facility.
> My recommendation to this facility would be to work with the DON
> to get her support and write a policy to request that they order a
> chest xray on all patients with anything other than a PIV when
> they arrive.  After they get the chest xray results, they can then
> contact the MD for orders, stating that their policy is not to use
> midclavicular catheters at that facility. Suggest that they pull
> them back to Midlines as an alternative, or use their  line
> placement service to replace to a PICC if they need a central
> line. (like for Vanco)
> The only way they would be protected from backlash from the MD is
> with a facility specific policy. 
> You may also want to suggest they get one or two nurses trained to
> place PICC lines, which would decrease the costs involved in
> getting these lines replaced.  Does your pharmacy offer a PICC
> class?  I found that to be very effective in getting the right
> line for the right patients.
>
> Chris Cavanaugh, CRNI
>
> ----- Original Message -----
> From: [EMAIL PROTECTED]
> Date: Thursday, March 16, 2006 1:42 am
> Subject: Re: Midclavicular catheters
> To: [EMAIL PROTECTED], [EMAIL PROTECTED],
> [EMAIL PROTECTED]
>
> > Also, the term PIC is outdated. This was determined years ago to
> > be confusing and inappropriate terminology, not to mention
> unsafe
> > tip termination.
> > LA
> >
> > -----Original Message-----
> > From: Lynn Hadaway <[EMAIL PROTECTED]>
> > To: Dawn Ellis <[EMAIL PROTECTED]>; [EMAIL PROTECTED]
> > Sent: Wed, 15 Mar 2006 16:01:23 -0500
> > Subject: Re: Midclavicular catheters
> >
> >
> > If you are talking about the hospital that I am thinking about
> in
> > this same situation, I wonder if there is any hope of them
> > changing. I also would not use those catheters. So before I
> > accepted the patient I would insist they be changed or I would
> > refuse to accept the patient. Once you accept the patient, my
> > understanding is that you are then obligated to provide their
> > care. Also do you have data of complications with their
> catheters?
> > You can also have your legal dept find documentation of a case
> in
> > Volusia County FL that resulted in a huge settlement for the
> > patient with a midclavicular locationi. Lynn
> >
> >
> > At 2:27 PM -0500 3/15/06, Dawn Ellis wrote:
> > I am continuing to see midclavicular catheters being placed in
> one
> > of the largest most (supposedly) progressive hospitals in the
> > nation. I am not sure how to handle this problem. I consult for
> > a long-term care pharmacy and some of my facilities admit
> patients
> > with midclavicular caths because the hospital informed them the
> > resident had a PIC, not PICC. I have educated the staff and our
> > procedure manual states that we need a chest X-ray prior to
> using
> > any type of central line. When calling the attending physician
> > for the long-term facility and advising him of the complications
> > that may arise, he still insists on using the existing line. My
> > advice to the facility is that I would not use this line for 6
> > weeks of vancomycin or any other medication that should not be
> > infused peripherally. I feel that I have been beating my head
> > against the wall for 4 years now and I am still not sure why
> this
> > hospital with a vascular access team is not doing the correct
> > placement. Thoughts?
> > Advice? Help?
> >
> > Dawn D. Ellis, RN, CRNI, OCN
> > Clinical Nurse Consultant
> > Neil Medical Group
> > 800 862 4533 ext 3443
> >
> >
> >
> >
> >
> > --
> >
> > 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
> >
>