If that only happened everywhere. I would be amazed to be able to know within minutes instead of the long waits I have had in the past.
>>> "NAncy Moureau" <[EMAIL PROTECTED]> 08/08/2006 10:07:19 PM >>> I had a great experience with portable xray today where a PICC was placed in long term care, xray came just as ordered just as the PICC was finished, took the shot (flexible enough to make adjustments based on what was needed) pulled the film up almost immediately on a laptop, made light/dark adjustments with full zoom etc and voila finished SVC! They immediately transmitted to the reading MD and then placed the xray on a CD for the patient record. Wow was I impressed. Nancy Moureau, BSN, CRNI PICC Excellence, Inc [EMAIL PROTECTED] 1-888-714-1951 ---------- Original Message ---------------------------------- From: "Dianne Sim" <[EMAIL PROTECTED]> Reply-To: [EMAIL PROTECTED] Date: Tue, 8 Aug 2006 09:30:42 -0700 > >It's more a matter of getting the CXR taken, so it can be read. > > > >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 information >that is confidential and prohibited from further disclosure under law. If >you have received this e-mail in error, its review, use, retention and/or >distribution 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:[EMAIL PROTECTED] >On Behalf Of Lynn Hadaway >Sent: Tuesday, August 08, 2006 8:20 AM >To: Nadine Nakazawa; [EMAIL PROTECTED]; [EMAIL PROTECTED] >Subject: Re: Wire Pulls > > > >The other approach would be to have the PICC nurses assess tip location >themselves without having to wait on a complete chest xray reading from the >radiologist. Lynn > > > >At 1:27 PM -0700 8/7/06, Nadine Nakazawa wrote: > >The reality is that the Radiology Dept is swamped with orders for all kinds >of x-rays all over the hospital and the idea that they are expected to do a >CXR within 15 to 20 minutes is not possible or reasonable. It depends on >their volume, their staffing, if any rooms or machinery is down, but overall >hospital volume and procedures is way up year after year, and they are >expected to do it all. As our PICC volume increases, we have to wait >longer for CXR results. At the present time, we are doing 8 to 12 PICCs a >day, which means at least that many CXRs and an occasional extra one if it's >malpositioned, or we can't see the tip if the patient is extremely obese, >confused and the quality of the film is too poor. We do digital CXRs and it >can still be not clear. > >The answer to Diane's question, IMHO, is to extend the hours of the PICC >team so that at least one team member stays later hours to "finish" up all >the PICCs. We usually have one nurse who works til 7 PM (I and another PICC >nurse work 12 hours shifts). It doesn't really matter how you configure >your staffing schedule, but you do have to take into consideration that >"finishing" a PICC is a lot more than just "pulling a wire." If the pICC >continues to be malpositioned, the nurse must be qualified to either >reposition the PICC, or know what to do: page the referring MD to let them >know you will be referring it to IR, or pull the line, etc. There are >enough different scenarios that I have encountered after hours that I would >not want a nurse without anyone else to discuss these situations with to be >alone with that kind of decision making. > >Others may feel differently, unless you are talking about only one or two >nurses who will be educated and trained to complete these PICCs. In other >words, they should take a complete PICC insertion course to know the >consequences of PICCs that are placed too deep, malpositioned, too shallow, >bleeding, tip can't be seen clearly, etc, etc... I wouldn't want the >liability for overseeing a program and having nurses help out without that >education. > >Nadine Nakazawa, RN, BS, OCN > >PICC Program Coordinator > >Stanford University Hospital and Clinics > >Stanford University Medical Center > > > _____ > > >From: "Lynn Hadaway" <[EMAIL PROTECTED]> >To: "Diane Zawora" <[EMAIL PROTECTED]>, [EMAIL PROTECTED] >Subject: Re: Wire Pulls >Date: Mon, 7 Aug 2006 09:51:39 -0400 > >blockquote, dl, ul, ol, li {padding-top:0;padding-bottom:0;} > >I would not recommend it. There are numerous reports to manufacturers of >catheter damage during wire removal if not done correctly. Plus what would >happen if they dislodged the catheter during this procedure. How long are >these patients left with the stylet wire in place waiting on xray? This >should be no longer than 15 to 30 minutes, in my opinion, and the inserter >should not leave until the job is finished. If I were these med-surg staff >nurses, I would refuse to accept this task and the accompanying liability. >Lynn > > > >At 6:38 AM -0700 8/5/06, Diane Zawora wrote: > >Our IV team is considering having IV nurses who are not PICC insertion >qualified pull quidewires after chest x-ray confirmation. Most of the time >this would occur after our PICC team is gone for the day. Any one out there >have any thoughts about this practice? > > > >Diane Zawora CRNI > >Infusion Therapy Dept > >Munson Medical Center > >Traverse City, MI 49684 > >[EMAIL PROTECTED] > > > > > > > > > >-- > >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 > > > >[Non-text portions of this message have been removed] > > > >MedComp Proud Sponsor of the Vascular List Serve. >Yahoo! Groups Links > ><*> To visit your group on the web, go to: > http://groups.yahoo.com/group/vascular/ > ><*> To unsubscribe from this group, send an email to: > [EMAIL PROTECTED] > ><*> Your use of Yahoo! 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