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Right on sister! I had a patient just two weeks ago that had chest pain and runs of v-tach all of a sudden out of the blue. I had put a PICC in about an hour previous to the episode. When I came back up to do patient teaching, they had already done a stat EKG, stat cardiac enzymes, and respiratory was drawing a blood gas. I jumped in the middle, pulled the dressing off the PICC, and pulled it back 3cm. The chest pain and ectopy stopped immediately. The CXR showed the PICC in the lower SVC. The doc was very embarrassed, but the nurse did not realize this could happen. We are currently thinking about doing an in-service for the non monitored floors so that they know this is a possibility if the patient has a PICC.
Heather Nichols RN BSN CRNI
Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Pat Deisch" <[EMAIL PROTECTED]> 5/11/2006 9:30 AM >>> This really sounds like a great study if anyone is willing to take it
on. We've had a few incidences of Vtach which resolves as soon as the PICC is pulled back into the SVC. This is a very small number, but can cause seroius problems, create many more unncessary costs/tests/risks for the patient if the nurse doesn't put together that the PICC slipping into the atrium could cause ectopy. We're currently exploring how we can get a better handle on this. Glad to hear we are not alone. This list serve is great to hear others experiences and thoughts. Pat Deisch MSN, RN BryanLGH Medical Center ----- Original Message ----- From: "Dianne Sim" <[EMAIL PROTECTED]> Date: Wednesday, May 10, 2006 8:56 pm Subject: RE: telemetry and PICCs > Admittedly, the risk is here, but how big a risk is it, and at > what point > can you justify the extra cost of telemetry/monitoring? Our team > has placed > 5,567 PICCs at the bedside since 1/1/2000, with approx. 80% without > monitoring, and not had a single problem with ventricular arrythmias > perceived. > Regards, > > > Dianne Sim RN > CEO & President > > > > > > > > IV Assist, Inc., > > 2675 Appian Way > > Pinole, CA 94564 > > Phone: (510) 222-8403 > > Fax: (510) 222-8277 > > Email: [EMAIL PROTECTED] > > > > > > > > Confidentiality Notice: This e-mail and any attachments are > intended only > for the use of those to whom it is addressed and may contain > informationthat is confidential and prohibited from further > disclosure under law. If > you have received this e-mail in error, its review, use, retention > and/ordistribution is strictly prohibited. If you are not the > intended recipient, > please contact the sender by reply e-mail and destroy all copies > of the > original message and any attachments.[v1.0] > > _____ > > From: [EMAIL PROTECTED] [mailto:owner- > [EMAIL PROTECTED] Behalf Of Heather Nichols > Sent: Tuesday, May 09, 2006 11:54 AM > To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED] > Subject: Re: telemetry and PICCs > > > > 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 > thatsomeone 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 > recognizeectopy, 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 > telemetryduring PICC placements? I think this is overkill but I > need all the info I > can get before they act on this. > > Sue Kilbourne CRNI, OCN > Clincail Manager Vascular Access/Infusion Services > Asante Hospital Systems > > > > NOTE: The information contained in this message may be privileged and > confidential and protected from disclosure. If the reader of this > message is > not the intended recipient, or an employee or agent responsible for > delivering this message to the intended recipient, you are hereby > notifiedthat any dissemination, distribution or copying of this > communication is > strictly prohibited. If you have received this communication in error, > please notify us immediately by replying to the message and > deleting it from > your computer. > > E-mail has the potential to have been altered or corrupted due to > transmission or conversion. It may not be appropriate to rely upon > thisE-mail in the same manner as hardcopy materials bearing the > author'soriginal signature or seal. Thank you. AsanteR Health System > > > ----------------------------------------------------- > Confidentiality Disclaimer > > This message, including any attachments, is confidential, intended > only for > the named recipient(s) and may contain information that is > privileged or > exempt from disclosure under applicable law, including PHI > (Protected Health > Information) covered under the Health Insurance Portability and > Accountability Act (HIPAA) of 1996. If you receive this message > in error, > or are not the named recipient(s), please notify the sender or > contact the > University of Louisville Health Care I.S. helpdesk at 502.562.3637 > to report > an inadvertently received message. > >
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