I had always known that home care was as Chris described but I
always thought that LTC had more control over who came in their doors.
With the aging of America and the demand for skilled nursing home
beds, I really do not see that nursing homes must cater so strongly to
the demands of referring physicians. In fact my mother has been in 3
different nursing homes now and the physician was not involved in
making any of those choices. Those decisions were made exclusively by
the hospital providing our family with information about each facility
then we went to check them out and determine which ones were
acceptable to us. Lynn
At 10:36 PM -0500 3/16/06, VICTORIA SALLESE wrote:
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
> >
>
--
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 Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
