PIVC
How many attempts at cannulation/venepuncture can one clinician have per patient?
Two
Describe the process of successfully flushing a PICC line?
- Use 10 mL syringe only
- Pulsatile flush: use stop/start motion, 1mL at a time
- Clamp line under positive pressure (clamp as flushing last mL of saline)
Why would a patient have a port inserted?
Patient has difficult venous access and ongoing need for accessing veins for treatment/blood collection e.g. chemotherapy.
Which tubes would you need to collect and FBC, EUC, CMP and blood cultures?
FBC - purple (EDTA)
UEC, CMP - red if not urgent, green if urgent (serum)
Blood cultures bottles
At what point should a PIVC be removed?
- 72-96 hours
- Any indication phlebitis/inflammation/infection/extravasation
- When it is no longer required
What solution should a PICC site, PICC line and needless connectors be cleaned with?
2% chlorhexidine70% isopropyl alcohol
How does a port differ from other central lines seen on the ward?
- Implanted under the skin
- Can be flushed every 6 weeks when not in use
- Patient can swim, shower, go about daily activities as normal when port is not accessed
What are the labelling requirements for collecting a group and hold, and for how long is a group and hold valid?
Handwrite all details on label, ensure all match collection form exactly.
(Best practice would be to have patient/2nd staff member double check)
G+H valid for 72 hours
What information should be documented regarding a PIVC?
- Date and time inserted
- Clinician & location patient cannulated
- VIP score
- Patency
- Skin condition
- Dressing condition
What information should be documented every shift regarding a PICC line?
- Date, time, location inserted
- Number of lumens
- Securing device
- Patency
- How patency is confirmed
- Dressing condition
- Skin condition
- Last dressing & needless connector change
- Solution dwelling in line
- Clinician flushing line
How is a port accessed?
Under strict ANTT by a competent clinician with a gripper needle, confirming blood return and patency.
You have a patient you suspect is developing sepsis. The medical team are on their way and ask if someone is able to collect bloods prior to their arrival. What bloods would be appropriate to order?
FBC
EUC
CMP
LFTs
CRP
Lactate
Blood cultures x2
Coags if severe case/bleeding or clot suspected
G+H if anaemia suspected/likely
Describe the steps in the DIVA pathway?
- Patient assessed as a DIVA
- Escalate to more experienced staff member
- Escalate to medical team for consideration of ultrasound guidance
- Escalate to anaesthetics/ICU; consider need for CVAD
What options are available if you cannot confirm blood return/flush a PICC line lumen before using the line?
- Examine line ensure not kinked
- Change needleless connectors
- Gentle flush/aspirate with saline ad 10mL syringe only
- Reposition patient supine position, arm extended, head turned away from site
- Ask patient to cough
- Escalate to medical team ?removal
- If MNCCI patient - consider escalating to MNCCI for alteplase
Can someone in your team have a practice at accessing a port?
Great job
Can someone in your team demonstrate collection of blood cultures from a PICC line?
Well done!