I note that in the INS Standards 2006 edition (pg S38 sec III-D), the
placing of a blood pressure cuff and taking blood pressure readings "distal
to the catheter's location" read as: on the forearm below the PICC, was
regarded as acceptable...new for this year.
So...I am not sure there exists research on this intervention but am asked
by nursing who have patients with mastectomies or grafts if they can take a
BP on the wrist below the PICC.
Scott
----- Original Message -----
From: "Nadine Nakazawa" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>; <[EMAIL PROTECTED]>
Sent: Tuesday, July 11, 2006 7:25 AM
Subject: RE: DVTs since using mst/ PICC tracking software
Yes, yes, and yes. You are able to place PICCs in MUCH sicker patients
because you now have MST & US. PICCs are likely the best choice in a
central line, but for all the reasons you have listed ( and more) these
patients are hypercoagulable and at risk.
A couple of points not brought up by others:
1. Make sure that you warm up the arm. Hot pack it with a wet (at hot of
tap water without burning your inner wrist) to vasodilate the veins. Yes,
it will go back to normal size later, but the larger the vein at the time
of insertion, the less trauma.
2. There is a learning curve with US. As you become more proficient, you
will nail the veins with less trauma.
3. Like Lynn said, use power free gloves or rinse your powdered gloves
with sterile saline for irrigation.
4. Make sure that the NA's and RNs know to NOT do BPs or tourniquets on
the PICC arm. If the patient cannot have a BP on the other arm (severe
hemiparesis, mastectomy, AV fistula), make a sign above the bed and note
in the chart to do BPs on one of the lower legs and record it as such.
This may seem logical, but it's not to everyone.
5. I always emphasize that this is a risk when getting informed consent
from the patient or family.
Nadine Nakazawa, RN
PICC Program Coordinator
Stanford Hospital
From: "Jenny Graziani" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: DVTs since using mst/ PICC tracking software
Date: Mon, 10 Jul 2006 18:28:33 -0400
Hi Venous Group,
I am in need of some advice. We started using MST/US for our PICCs in
February. We have been progressing well, but we have had a few patients
develop DVTs. Did they develop DVTs because of the PICCs? Did they
develop DVTs because they had a PICC and were bedfast, post-surgical,
etc. etc. etc.?? I don't know but I'm feeling the pressure. I am the
primary PICC person and and one other person ready to go now. Two of the
four patients actually thrombosed from the right basilic to the
subclavian!! I don't remember these issues before MST/US, but we are
able to put PICC lines in people we never were able to get before (i.e.
sicker, obese, critically ill).
Could you all please send me some advice on how I should proceed? I
know statistically it probably is an acceptable percentage, but if there
is something I improve on, I'm all for it. I could also use some help in
finding references to published literature regarding this issue.
I am also looking for a software program to track PICC line data at our
hospital. We use Cerner in our facility--totally useless for data
retrieval and tracking.
Thanks to all of you for all of your help!!
Jenny Graziani RN CRNI
Monongalia General Hospital
Morgantown, WV 26505
