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When to Pick a PICC: Top 5 Signs That Your Patient May Need a PICC

1.       The IV site does not last.

If you’ve had a patient on intermittent medications for a few days, and the IV site had to be changed daily or close to it, and you suspect that the patient will need a few more days of IV therapy.  Chances are that this patient may be a candidate for a PICC line.  A rule of thumb is 5 days or more of IV therapy.1

2.       The patient has poor access.

These signs can be cumulative.  If the patient is expected to need IV therapy for 5 days or more AND their veins are difficult to find, definitely ask for a PICC order.

3.       Frequent blood draws are needed.

Particularly if number 2 is true, save the patient from the discomfort of multiple venipunctures – ask for a PICC order.

4.       Diagnosis indicates IV therapy post hospital discharge

Certain diagnoses will require moderate to long term IV therapy.  Deep tissue and organ infections such as an infected diabetic foot ulcer, osteomyelitis, or endocarditis require 4 to 6 weeks of IV antibiotics, and gastric diagnoses such as a small bowel obstruction will require moderate to long term IV nutrition.

5.       Caustic IV Medication Ordered

If the medication to be infused is known to be an irritant or vesicant (irritates the vein/ causes phlebitis or worse, tissue damage or necrosis), a PICC may be indicated.  Does the medication have a high or low pH? The rule is less than 5 or greater than 9 = do not infuse through a peripheral vein.  Extreme examples are Vancomycin at 2.5 or Phenytoin at 12.  How about the osmolality of the infusion, is it greater than 600 mOsm (example 10% dextrose)?  If so, a PICC may be indicated. 1

Of course there are other types of central line choices, however PICCs are often preferred over other central lines due to the convenience of insertion and removal,  and avoidance of some of the more serious insertion related complications of chest or neck placed lines.

That’s my top five reasons.  If you can think of more- we can keep the list going.  Maybe we can get this to the top 10 reasons to pick a PICC?

 

Reference: 1The Infusion Nurses Society Standards of Practice, 2011.

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