2/11/2024 0 Comments Power picc double lumen![]() To reduce the risk of complications, morbidity, and mortality, practitioners who manage VADs need to be educated and constantly updated about correct use and care of them. These advances include the use of needle-free devices, securement devices, and antiseptic caps, as well as chlorhexidine-impregnated discs and dressings (Apata et al., 2017 Kelly, Jones and Kirkham, 2017 Wang, et al. In addition to advances in insertion techniques, which include the use of ultrasound guidance (Hill, 2019) and the use of electrocardiography to determine catheter tip position (Pittiruti, 2015), advances in techniques and technology for the post-insertion management of VADs have also erupted. Over the past few decades, there have been many scientific advances in technology and techniques in the field of vascular access. Broadhurst, Moureau and Ullman (2016) agree and claim that the prevention of complications is possible with appropriate evidence-based practices. (2016), many such complications and failures are preventable. Most post-insertion complications are attributed to poor care and maintenance practices. They can occur in all devices including a PICC and are a significant burden on healthcare workers. It is now accepted that the presence of any VAD immediately places patients at risk of complications. Choose the right one for your patient. Why should they have to have a PIV for a contrast injection that is put in at high pressures and flow rates when they already have a picc line? Does this make sense? Why would I choose a non-power injectable line over a power injectable picc if they are the same french size? The cost difference is less than if I have to go start an IV for the CT scan! If I need a PICC, I hope I get the right PICC for me and what I need at the time of insertion, and I know that I would insist on my family members getting the right PICC so that they will not need repeated sticks when they have needs for any type of infusion therapy that may come.Although Vascular Access Devices (VAD) have many advantages, the burden of harm associated with them is significant. Contrast injectable, CVP monitoring, the variety of lumens, tip location system to go along with each. There are PowerPICCs from 4 Fr single lumen all the way up to 6FR Triple. The choice is yours and you should always do what is right for the patient. The right line placed for the needs of the patient. As Jerry said, there is no crystal ball that will tell you for sure who's who but there is no denying the patient's do receive these exams. In the real world, patient's who are in the hospital, especially those who are in the initial diagnostic work-up phase, need CT scans and MRI's with contrast. This is real world, not just the company line. At some point we have to all agree that care and maintenance is the real issue at times. Would not every one agree that if a line is flushed appropriately, it will stay patent? If a positive or neutral displacement cap is used according to the manufacturers guidelines, the lumens will stay patent? If the catheter has a built in valve, will it not clot if not flushed appropriately? What should the rep say about this? Can a rep be at the bedside to make sure the lumen is flushed after that blood draw? There is only so much they can do for us. I am always surprised when I see comments such as those who say they see increased clotting when using one open-ended polyurethane PICC over any other open-ended PICC. I have had them pulled out by patients, but never pulled apart. We use saline flushes and a neutral displacement valve. Our experience with occlusions and other complications has been the same or fewer than we experienced using Groshong PICCs. ![]() In addition to the power injection capability, we can also monitor CVP pressures if the patient ends up in the ICU. Over the past two or three years, the advantages of the Power PICCS have won us over to the point that we now use Groshongs only very rarely. We used to place Groshong PICCs in 100% of our patients. The superiority of power-injectable PICCs in the acute care setting are subtantial. Having no crystal ball, we often don't know for sure what therapy the patient will end up on, or whether home care will become an option. These lines are frequently placed during the diagnostic workup phase. I think the solution to this is that we will have to find better solutions to caring for these lines in the home care setting.
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