I agree 100% with Heather. We have arrhythmias in PICC patients quite often, yes, even V-tach. It may not happen on insertion, but later, and often when the patient is positioned on his/her left side. We have had patients transferred to ICU and put on drips, only to discover that the PICC line that used to be in the SVC is now down in the right atrium. Our cardiologists went so far as to try to get us to place PICC lines no farther than the subclavian. We were able to fend that off with good supporting data, but we do now measure only to the second intercostal space instead of the third. Our tips are then high to mid SVC. We also started placing a large bright sticker on the front of the chart that says "PICC" to help everyone remember that there is a PICC in this patient.
Wendy Erickson RN PICC Coordinator Luther Midelfort - Mayo Health System Eau Claire WI -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Heather Nichols Sent: Tuesday, May 09, 2006 5:59 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: telemetry and PICCs Tim, I take REAL offense when someone states that something does not exist just because it has not happened to them. It happens plenty. We have cardiac surgeons here at my facility (which is one of the top ranked trauma facilities in the United States) who strongly believe that we should not place PICC's in patients with cardiac ectopy problems or endocarditis. It has happened to me alone way too much to be a coincidence, or just my imagination. Dr. Tom Vesley has stated plenty of times in his tip placement lectures at AVA conferences, that it is a real possibility, and is only corrected when the PICC is pulled back. It is very patient specific, and I do not mean that it happens with everyone, but it can and does happen. Maybe you enjoy taking chances with your patients, but I don't. My licence is another thing I do not like to chance. I am not saying that you should go take the monitor off a CCU patient for your PICC placement, but if someone is gonna foot the bill for a monitor for PICC placements, it certainly cannot hurt. Just my 2 cents worth. Heather Nichols RN BSN CRNI Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Tim Talbert" <[EMAIL PROTECTED]> 5/9/2006 4:16 PM >>> I also have never had a patient experience any palpitations or other cardiac problems during PICC insertion. I know of no mechanism whereby atrial stimulation with a PICC inadvertently placed into the RA could cause VF or VT, it is a completely different mechanism. I for one do think you can be to careful. You are being to careful when you use up limited resources trying to prevent a problem that does not really exist, and this causes those resources to be unavailable to treat problems that do really exist. Tim >>> "Heather Nichols" <[EMAIL PROTECTED]> 5/9/06 >>> I have not seen much documented on this either, but anyone who does PICC placements knows it happens frequently. It is not exactly a study that someone would come in and volunteer for. I have often wished I could carry around a portable monitor to place on anyone I put a PICC in. It may seem like over kill, but I feel like you can never be too cautious. I myself have put a patient into v-tach while placing a PICC. It was barely in the right atrium. I would never have known if the patient had not had a monitor. He was sedated and therefore unable to verbalize. The cost would not be that much if you were smart about it. Get your own portable monitor, or have one in the room you are using to place lines. Any nurse placing PICC's for a living should be able to recognize ectopy, so you really do not need anyone else to monitor. Heather Nichols RN BSN CRNI Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Kilbourne, Susan" <[EMAIL PROTECTED]> 5/9/2006 1:23 PM >>> I just had a visit from our infection control MD. She states that the physicians/surgeons group have decided that they need to do telemetry when placing central lines and want to require it for PICC placements as well. I have one article from Pediatric Anesthesia that talks about V-tach with PEDS PICC placements but other than that, this is not something I have heard of doing on everyone. I told her my concerns with added cost, competency and having portable telemetry units available. Are any of you doing telemetry during PICC placements? I think this is overkill but I need all the info I can get before they act on this. 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