Help yourself by helping others with IV guide

Troubleshooting tips for PICC lines

Do you or your IV-trained nurses spend too much time answering questions on common complications with PICC lines? Wouldn’t it be nice if there were a way to help your non-PICC trained nurses resolve the simpler problems on their own? This month, Home Infusion Therapy Management provides you with a tool that allows you to do that.

Susan Jepsen, RN, CNSN, a nurse clinician with the department of pharmaceutical services at William Beaumont Hospital, a 1,000-bed community hospital in Royal Oak, MI, faced just such a dilemma.

"Just three of us insert PICC lines in the entire facility, both inpatient and outpatient," says Jepsen. "We had no choice but to delegate the responsibility of maintenance to all the nurses."

Jepsen did this by devising a PICC troubleshooting guide that lists common problems associated with PICCs on one side and troubleshooting tips from the least-complicated solution to a worst-case scenario on the other. (See guide, pp. 105-107.)

"This was our way to fend off emergency phone calls," Jepsen says. "Now if a nurse goes through the troubleshooting guide and still can’t troubleshoot on their own, they can call us." According to Jepsen, the guide is designed for use by nurses, not patients, to troubleshoot common complications such as phlebitis and dependent edema.

"Before they would call us, and it would be up to us to assess the patient and the therapy, and that could be a 24-hour delay," she says. "Now, the nurse can make the assessment, and we only have to follow up regarding whether the therapy can continue or if the line must be pulled and started somewhere else."

Hospital guide goes home

The guide is printed on index card-size paper and is accordion-folded to fit in a nurse’s pockets. The paper stock is also heavy, so it can stand up to regular use and abuse. Although it was designed for use in the hospital, Jepsen notes the guide is just as applicable for home care nurses.

"It goes through all the complications a nurse would encounter in the home, and you can then phone triage through this," she says. "When people can’t get a hold of us, they’ll call our pharmacist after hours, and he uses this to help phone triage."

The guide was recently revised, with areas addressing pulling lines and resistance to removal being added.

"We use Groshong catheters, which have little black tips at the end, so we don’t have to worry about catheter fragments," notes Jepsen. "If they get the black tip out, they know they got the entire catheter. Because of the built-in safety feature, all nurses in the hospital now are allowed to pull lines. However, resistance to removal became an issue, hence the necessity to address the issue in the troubleshooting guide.

Another change made was regarding suspected catheter-related sepsis. The information contained in the guide was revised to conform with the hospital’s infectious diseases department guidelines regarding when the line should be pulled and when a line could be left in.

Approximately 1,500 copies of the latest guidelines were printed, which is enough for every nurse in the facility to receive a copy. The latest version was printed on yellow paper, to differentiate from the original version, which was gray.

But printing a new version wasn’t all that was required to disseminate the new information. To make sure all nurses understood the changes, Jepsen held an inservice.

"With this particular troubleshooting guide, we re-inserviced everybody on PICCs, and then they were given the new revised version with the updates on it," notes Jepsen. "For this latest inservice, I simply went through the points on the guide so it would take just 25 minutes or so, barring a lot of questions."