PICC Line Placement is generally a planned and scheduled event
The PICC service has limited resources and works under Medical Director approved criteria for responding to calls after normal working hours. For pediatric patients, child life personnel and sedation team personnel are not always available on weekends and after hours. PICC team members are expected to come in while on call for the following circumstances:
1) Outpatients on life sustaining drips (Dobutamine, Flolan, Primacor)
2) Outpatients receiving continuous TPN (if not receiving continuous TPN will be done on the next business day).
3) Patients receiving vesicant drugs through a PICC line develops mechanical complications (disruption of catheter integrity, accidental dislodgement of catheter, etc)
For new admission patients needing access, or when unit staff is unable to establish a short peripheral IV the following options exist after hours since PICC placement is not considered an emergency access method over percutaneous central line placement:
1) Housestaff may place an external jugular or central line.
2) The interventional radiologist may be consulted.
3) Surgery may place a line at bedside.
Extra Assistance May Be Required
Pediatric patients require two and sometimes three staff members when placing PICC lines. For this reason, rarely ever will a pediatric patient be done after hours or on weekends and holidays. If, in the situations described above, it is absolutely necessary, staff from the patient's nursing unit and possibly the Medical Staff may be required to assist with the procedure. These arrangements will be made before the PICC service on-call staff arrives at the hospital.
Adult patients who are confused or with limited ROM/mobility, in the situations described above, will require staff from the patient's nursing unit to assist witht he procedure. These arrangements will be made before PICC service on-call staff arrives at the hospital.
Troubleshooting information is provided to all hospital units. However, if you have an urgent question regarding a PICC, you may beep a consultant at 835-4105