PICC LINE 101

You have just inserted a PICC line in a 42-year-old female who is scheduled to discharge home for home health daily chemotherapy treatment. You have not had an opportunity to review the patient's chest x-ray due to the number of PICC placements you have to insert. You receive a call from the radiologist indicating the PICC line is not cleared and has a complication. You review the x-ray and see this on the x-ray. What steps do you take to clear this PICC for use? What steps should you have taken to ensure there was proper tip position of the PICC line at cavo-atrial junction. Are there any patient factors that would impact proper tip position? How would you determine the appropriate length for PICC placement at the cavo-atrial junction.

A PICC line requested has been received for a 17-year-old male patient with cystic fibrosis on unit 3 North. You review the patient's medical record and his complete blood count shows a white blood cell count of 7.8, hemoglobin 11.5, hematocrit 32.9, lymphocytes 0.4%, and platelets 450. You notice he recently completed a 3 week regimen of Lovenox and his INR is currently 2.0. After reviewing the patient's medical record, you go and discuss the procedure to the patient. You noticed the patient's arm bruised with intravenous catheter with normal saline infusing in his upper arm that was inserted last night. Based on the scenario above, how does this patient's lab results play a role in your decision to place a PICC line? Explain the reasoning related to the lab result(s) which are critical in making this patient eligible for PICC line insertion. How does the patient's bruising and previous intravenous catheter factor into the PICC line insertion?

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