PICC Lines

PICC lines, or peripherally inserted central catheters, are a convenient healthcare treatment. A PICC line is a thin catheter that is inserted in the large veins near your forearm at the flex point. It can be inserted by a physician or by a specially trained nurse and is minimally invasive. People who can get PICC lines include "patients who have to receive IV therapy longer than five days, when there is difficulty maintaining peripheral access, for any infusions known to damage the inside of the vein, for infusion of total parenteral nutrition, patients with respiratory ailments that increase risk for using other central venous access devices, for patients receiving chemotherapy, and for any patients needing prolonged outpatient treatment that requires use of an IV." http://www.cpmc.org/learning/documents/nur-piccline-ws.pdf. I am going to further discuss how a PICC line is inserted, the benefits and the risks, safety of PICC lines, and caring for a PICC line.

It can also occur during blood transfusion or during dressing change. The insertion of central catheters can occur in the Interventional Radiology or sometimes at the bedside. Regardless of the where the insertion process occur, a sterile field must always be maintained and sterile techniques must always be employed to prevent any organisms from being introduced to the central line into the patient. According to The Joint Commission (2013), many organizations such as Michigan Keystone Intensive Care Unit Project and Institute for Healthcare Improvement are actually adhering to insertion bundles to reduce the CLABSI rates. The bundles include hand hygiene, maximal barrier precautions, chlorhexidine skin preparation, avoidance of femoral vein, and prompt removal of central catheter. Furuya et al. (2011) studied the effectiveness of the insertion bundle and how it impacts the bloodstream infections for patients in the Intensive Care Unit. As a result, lesser infection have occurred when the compliance is high. As mentioned, the site of the catheter also needs to be considered in the insertion process. Avoiding areas such as the groin to access the femoral artery is recommended because this area can be easily contaminated with urine or feces. In addition, after the insertion of a new central line, all the used IV tubing

Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile

Lewis et al. explain in Medical-Surgical Nursing, a central line is a catheter placed into a large blood vessel for a patient who requires frequent or long-term access to the vascular system. The authors explain that catheters are used for the administration of high volume fluids, medications that are irritating (such as chemotherapy), long term pain medication, blood products, parenteral nutrition, and hemodialysis. Kaiser policy states four different types of central line used for patients: Centrally inserted catheters, peripherally inserted catheters, injection implanted ports and hemodialysis catheters. Centrally inserted catheters

Article by Clancy (2009) explained central lines were a result of an estimated 250,000 blood stream infections and accounted for 30,000 to 62,000 patient deaths, then adding that each infection cost upwards of $36,000 and cumulatively add up to at least $9 billion in preventable costs annually. The article also explains how the mindset has changed from the cost of having a central line in place and expecting complications to lowering infection rates by an intentional interventional process/s. The article speaks of 5 basic steps to reduce CLABSI, hand washing, insertion techniques, skin cleansing, avoidance of certain sites and earlier removal of the CVC. Studies showed that these guidelines were only followed 62% of the time. The system was changed to ascertain that all the clinicians were in compliance. This prompted 5 interventions, education, a CVC insertion cart with all necessary equipment, physicians having to validate central line necessity, a concise checklist for bedside clinicians and the empower of nurses to stop procedures if guidelines were not followed. These low cost interventions from 11.3/1000 in catheter days in 1998 to zero in the fourth quarter of 2002.

A Foley catheter is a thin, sterile tube inserted into the bladder to drain urine ( ). There are many types of catheters such as a straight, indwelling, and condom catheters. A straight catheter is one that does not stay inside the person. It is removed immediately after urine is drained. An indwelling catheter is one that stays inside of the bladder for a period of time. And last, a condom catheter is one that has an attachment that fits onto the penis. This catheter is changed daily or as needed. For the purpose of this document, the care that is going to be performed will need to be performed on a patient/resident with an indwelling catheter.

PICC line- thin, soft, long catheter that is inserted into a vein in a child 's arm, leg or neck

Central line bundle is a group of evidence-based practice strategy for patient with central catheters, when implemented together, produce better outcomes than implemented individually (Institute of health care improvement, 2010.). The main elements of central line bundle are hand hygiene, maximal barrier precaution upon insertion, Chlorhexidine skin antisepsis, optimal catheter selection, and daily review of line necessity with prompt removal of unnecessary lines Aseptic technique when using and caring for a central line catheter can decrease the chance of contamination in this critically ill infants. Staff education on adherence to aseptic technique and strict central line care guidelines are essential to decreasing bloodstream infections.

PICCs lines have become well recognized as reliable central venous access devices (VADs), with lower potential for complications than short-term central venous catheters. PICCs first gained popularity in the 1980s, and their use has grown steadily since then. They were initially popular in many parts of the United States due to the need for venous access in home care patients. They have grown in popularity because of their reduction in potential complications and costs compared with short-term central venous catheters, and because PICCs can be inserted by registered nurses who have been trained in the procedure.

A percutaneous central line is entered into the patient’s subclavian vein. Because TPN solution is concentrated it is better to have CVC access in the subclavian vein so the solution has less distance to travel to its destination. This reduces the risk of the line clotting or damaging the vein.

A is antisepsis of the skin, the skin could have microorganisms on them that can travel with the needle in to a patient’s blood stream. The use of alcohol wipes, chlorhexidine are the important to use before the needle breaks the skin barrier. Rubbing the site where the IV will be placed and letting it fully dry is the best way to keep infection out of the patient.

When hearing a patient needs a peripherally inserted central catheter (or PICC) chances are they (or their loved one) are already suffering from one of several critical illnesses. PICCs are commonly thought of when a patient has cancer, kidney disease, or in the case of premature infants. The PICC is used as long term option when a regular intravenous catheter would be in a state of constant replacement.

In reviewing Heparin flushes in Central Venous Catheters (CVCs); one must first understand the importance of their placement. To properly investigate central venous catheter (CVC) care; documentation will focus on Heparin flushes as it relates to renal care. The renal dialysis patient undergoes CVC placement as a basis of receiving hemodialysis treatments. It is essentially the first access point placed in preparation of a more permanent access point. Central venous catheters, fistulas, and grafts are considered the lifeline of a dialysis patient. Their function and patency is of the utmost importance to the morbidity and mortality rate of a renal patient. “Venous catheters generally develop a fibrin sheath at the tip, which evolve into a clot due to body’s physiological response to the vein injury and the foreign catheter 1 and subsequent catheter obstruction.” (Journal of Evolution of Medical and Dental Sciences, 2014, pg. 46).

A PICC line (peripherally inserted central catheter) is a thin tube that is inserted in a vein in a patient’s arm and is advanced toward the heart until it reaches the superior vena cava. A chest x-ray confirms the placement of the PICC line. It is used for IV administration of medications and antibiotics. Chemotherapy and TPN (total parenteral nutrition) can also be administered and blood samples can be drawn. The PICC line can last up to a year. Trained professionals such as PICC-certified nurses are able to do both insertion and removal. Do not put a blood pressure cuff on the same arm as the PICC line because it could fracture the IV line.

The use of intravenous therapy in the hospitals is now considered a routine therapy. In 2016, DeVries and Valentine stated that 70% to 80% of hospital patients have peripheral intravenous lines at some time during their stay. A peripheral intravenous (PIV) line is a small hollow tube (catheter) that is inserted into a vein and can be connected to special tubing. PIV line is commonly used to administer medications or fluids directly into the vein. The article “Intravenous Therapy: A Review of Complications and Economic Considerations of Peripheral Access,” states that the history of intravenous (IV) therapy dates back to the Middle Ages. Dr. Thomas Latta pioneered the use of IV saline infusion during the cholera epidemic and in the 20th century, two world wars established a role for IV therapy as routine medical practice (Dychter, Gold, Carson, & Haller, 2012).