Those are the great
experiences that keep us in this business!
Alma Kooistra
RN, CRNI
----Original Message
Follows----
From: "NAncy Moureau" <
[EMAIL PROTECTED]>
Reply-To:
[EMAIL PROTECTED] To:
<
[EMAIL PROTECTED]>
CC:
<
[EMAIL PROTECTED]>
Subject: Re:
[vascular] RE: Wire Pulls
Date: Tue, 8 Aug 2006 22:07:19
-0400
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] >
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>
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>Confidentiality
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_____
>
>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
>
>
>
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