What Is The Difference Between A Picc Line And A Midline
A midline is 3 to 8 inches long and is usually inserted in or near the bend of the arm the tip of the catheter should end before the shoulder. This type of catheter does not require an X-ray after insertion and can be used for most antibiotics and other therapies lasting up to six weeks.
A PICC line, or peripherally inserted central catheter, is also inserted in or near the bend of the arm, but its tip goes past the shoulder and stops just outside the heart. A PICC requires a chest X-ray after insertion to make sure that the tip is in the correct place. This type of catheter can be inserted by a nurse or a doctor, either at the doctor’s office or another place that has easy access to an X-ray facility.
PICCs can remain in place for a year and sometimes longer without complication. There is no maximum time they can remain inserted, as long as there are no complications with the insertion site or the catheter itself. They are used for TPN , IV antibiotics, chemotherapy and any other therapies that may indicate the need for a PICC line.
Flushing Your Picc Line At Home
Your peripherally inserted central catheter line is used to deliver medicine or feedings. Its a long, flexible tube that goes into your vein. To care for your PICC line, you will need to flush it. This means youll need to clean it with a solution as directed by your healthcare provider. This keeps it from getting clogged or blocked. A clogged or blocked PICC line will need to be taken out and replaced.
Receiving Antibiotic Treatment Through Ivs
Most of the time, intravenous antibiotic treatment is provided in a hospital. However, when it is safe and appropriate, antibiotic therapy can effectively treat patients at home or another healthcare facility. Each year, over 250,000 patients are successfully treated with IV antibiotics at home.
The antibiotic is administered through a small narrow flexible tube called a catheter or IV line, which is inserted into a vein using a needle. The needle is removed, and the IV line is left in place and secured by a dressing. There are different types of IV lines available, and the one chosen for your treatment will depend on your veins and how long you will need the antibiotics.
For example, patients with small peripheral veins often utilize something called PICC lines , where medication is administered directly to the heart. Considering PICC lines must be flushed daily, and their dressings have to be inspected and changed, patients with PICC lines must avoid getting them wet or dirty.
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Recent Practice In Southampton
In June 1999 the medical directorate started an OPAT pathway to treat selected patients with an acute episode of cellulitis . Southampton patients are asked to return to the hospital on a daily basis. The intravenous antibiotics used are ceftriaxone, gentamycin and teicoplanin. Patients who are in a lot of pain or are vomiting or feel unconfident about coping at home are admitted for 48 hours and then reassessed for OPAT. In 12 months 78% of patients with cellulitis were successfully treated via an OPAT pathway.
Why Is Hand Washing So Important With Iv Therapy
Any time there is a penetration to the skin, there is a break in the skin’s protective system, and therefore the possibility for infection exists. Since your skin’s protective system was compromised with the insertion, infection may occur at the insertion site or in the bloodstream.
Organisms that ordinarily live on the skin can become harmful if they enter the body. Most infections are spread by hand contact hands and fingers carry the most organisms. Because your IV catheter and IV site need to remain as clean as possible, everything touching them must be sterile. This is why you must wash your hands for 15-30 seconds with soap and warm water before touching your PICC line or IV site.
It’s equally important to wash your hands thoroughly afterward so you do not spread any potential infection to other people or other parts of your body.
Here are some additional tips for hand washing:
When to wash your hands:
- Before and after touching intravenous tube or intravenous supplies
- Before eating, drinking, handling or serving food
- Before and after contact with sick people
- After touching sheets, bandages, towels or any patient care item
How to wash your hands:
- Use plenty of antibacterial soap.
- Scrub between fingers, palms, back of hand and wrist.
- Scrub for at least 10 seconds.
- Clean under fingernails.
- Use a clean towel to gently dry your hands.
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Outpatient Iv Antibiotics Home/snf Infusion Orders
Outpatient Parenteral Antimicrobial Therapy
Drug name, dosing, frequency, and duration: _
Anticipated last day of treatment: _
Intravenous line care plan: Biopatch dressing, change on first day of care, qweek and as needed. Alteplase prn for clot.
Weekly lab orders: _
Additional Supplies for IV Antimicrobials: _
Clinical Information and Follow Up:
Ordering Physician : _
Discharge Inpatient Resident: _
Outpatient Physician Continuing Care and following weekly labs : _
Diagnosis including microorganism: _
Intravenous line type and date of insertion: _
Home nursing agency name/contact #: ****
Pharmacy name/contact #: ****
Scheduled outpatient appointments: ****
Scheduled appointment of outpatient physician continuing care and monitoring weekly labs if not PCP if not listed above: _
Office and Fax # for outpatient physician continuing care and monitoring weekly labs: _
**Home health agency must notify outpatient physician continuing care immediately if the above orders cannot be fulfilled during the course of treatment.
Diagnosis: Infective endocarditis with streptococcus viridans.
Line Type: PICC
Line Care Plan: Biopatch dressing, change on first day of care then q week and prn soilage or loss of integrity.
Medication: Ceftriaxone 2 gram IVP daily x total of 28 days, then reassess.
Lab orders: qWeek CBCd, CMP, ESR, quantitative CRP. Fax lab results to _
Home nursing agency: _
Guidelines For Administering Through A Picc Line
- Wash your hands. Use warm water and soap to scrub for 1 minute. Wash between fingers and rinse thoroughly.
- Dry your hands. Use a fresh paper towel and use it to turn off the water so that you do not touch a dirty surface after washing. Set the paper towel aside, and throw it away after the IV care is done.
- Put gloves on.Always wear medical gloves when touching and administering IV antibiotics. Be sure to keep gloves clean at all times and discard after use.
- Prep injection site. Wipe down all IV antibiotics injection sites with alcohol prep before injection. Wipe the PICC line opening with alcohol before attaching it to the IV.
- Hang the IV bag. The drip chamber should be at least 18 inches above your head.
- Make sure everything is clean and sterile. Always clean the catheter port with an alcohol wipe before use. Flush the catheter with saline or heparin as directed by your medical team.
- Attach IV and begin. Attach the IV tubing to your catheter and secure it with tape. Start the medication as directed by your doctor.
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Benefits To The Patient And Hospital
Patients benefit from an OPAT pathway because they receive care from a focused team and are not exposed to hospital-acquired infections. Antibiotics can be prescribed to OPAT patients that are not appropriate for hospital patients. Clindamycin is an example of an effective antibiotic for treating osteomylitis, which cannot be used in hospital because the drug alters the gut flora, making patients susceptible to bacteria from other hosts – for instance, Clostridium difficile.
What Are The Contraindications For The Picc Procedure
A key contraindication is that patients on anticoagulant therapy who have an INR blood test result greater than 2.0 cannot undergo the procedure. In addition, certain conditions may affect which veins are safe for the insertion site.
An upper extremity vein cannot be used for a PICC insertion if there is a history of any of the following in the region of that upper extremity:
- major shoulder surgery
- venous thrombosis
- axillary lymph node dissection
Similarly, a vein should not be used for a PICC insertion in any place on the body where the skin has a local dermatitis, cellulitis, burn injury, abscess or infection.
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Why Did A Lehigh Valley Pharmacy Services Employee Ask Me About My Phone Refrigerator And Running Water When I Came Home From The Hospital
We need to know you have a working phone, so that we can reach you and you can reach us at any time, for questions or more urgent concerns. We need to be certain that emergency medical services can be called from your home for anyone at any time.
Many drugs require refrigeration, so we need to know your refrigerator is clean and in good working condition. This keeps the drug safe by keeping it clean and at the correct storage temperature.
Cleanliness is very important in everyone’s life, and especially while you receive your IV therapy. We need to be certain an adequate supply of fresh clean water is available for hand washing and for keeping your immediate surroundings clean. All of these questions are part of making sure your home is safe for you to receive home care.
What Is The Difference Between A Hickman Catheter And A Picc Line How Do I Know Which Is Right For Me
The final decision about which type of IV line is best for you is made jointly by you and your doctor, taking into account certain factors.
Some considerations include:
- How long will the IV therapy last?
- What type of daily activities does the patient perform?
- Is the patient concerned about others seeing the catheter?
- Does the patient have any wounds, burns or rashes on the arms or chest?
These issues are important because PICCs are not recommended for lifetime IV therapy. PICCs are less invasive and less risky to insert because no sedation is required and there is no risk of lung puncture. PICCs also have a lower rate of infection because the skin temperature and bacteria count in the bend of the arm are lower than in the chest. PICCs are not recommended for people who perform repetitive arm-bending activities, because the catheter could become dislodged.
Hickman catheters are surgically inserted by a doctor into a patient’s chest. Approximately 4 to 6 inches of catheter are visible outside the patient’s chest. This type of catheter is more risky to have inserted because of the anesthesia and because the needle used to insert it is inserted near the upper tip of the lung. This can lead to an accidental, but rare, puncture of the lung.
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Inject The Flushing Solution
Wipe the port with alcohol.
Open the clamp, if there is one.
Take the cap off the needle or tip of the syringe. Insert the needle or tip into the port.
Push the plunger in slowly and smoothly. Dont force the plunger. You shouldnt feel any pressure when you push the fluid into the PICC line. If you do, stop right away.
Issues To Be Addressed When Implementing Opat
– Training: the nurses working in the clinic are all experienced registered nurses with further education. All staff are trained in teaching and assessing and have experience in teaching other patients how to self-medicate and are trained in intravenous administration. No further training is required
– The line manufacturer has provided PICC insertion training with supervised practice and assessment by the trusts intravenous nurse practitioners
– Operational pathways have been written and agreed by the microbiologists, clinical directorates, pharmacy, nursing and risk management. Patient-held notes have been developed with detailed agreements on how, when and by whom the patient should be reviewed
– Out of hours advice, 18.00-08.30: Patients can ring the emergency medical unit for advice. An algorithm guides the nurse in deciding whether the patient needs to attend A& E for immediate assessment by a doctor, or should return to the clinic the next day
– Patient information leaflets on self-administration have been written
– Pharmacy has costed the provision of a central intravenous service, where antibiotics are prepacked under sterile conditions and delivered to the patients home. This is not essential patients in Dundee are taught how to mix their own drugs
– A safe, inexpensive ambulatory pump, the sidekick infuser, has been identified for home use
– Audit: all patients will be registered on the OPAT International Registry.
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Fyi: Not For Inclusion In Note
First dose of any IV antibiotic is usually given in the hospital to avoid possible anaphylaxis at home. Anaphylaxis kits are available.
Time medications so that at least 2 teaching sessions with the home health nurse are possible before the patient has to self-administer an IV dose .
Obtain time of home nurse availability and work around it, as this is often the biggest barrier to discharge.
Nursing will typically teach the patient or family member how to administer and then go out weekly to draw labs and change PICC dressing.
ID consult can assist with organizing doses and drugs given in the hospital prior to discharge to accommodate the transition to home care and avoid as much time without adequate drug in patient and still be able to coordinate with home care.
Home nursing and home pharmacies need to coordinate with each other and the patient/family for delivery of drug to the home or hospital. Also verify that the address where the patient plans to go and the contact phone numbers match those on the face sheet/in Cerner.
Consider PO or a hep-locked IV in place of PICC lines. The choice of delivery method should be confirmed prior to PICC placement.
In general, do not change the drug or dosing schedule for the benefit of the home nursing agency. Call ID consultant with questions about what is feasible at home.
Avoid PICC lines in patients with IVDU histories. Midline catheters may be more appropriate.
When To Seek Medical Care
Pain or burning in your shoulder, chest, back, arm, or leg
Fever of 100.4°F or higher
Signs of infection at the catheter site
Coughing, wheezing, or shortness of breath
A racing or irregular heartbeat
Muscle stiffness or trouble moving
Tightness in your arm, above the catheter site
Gurgling noises coming from the catheter
The catheter falls out, breaks, cracks, leaks, or has other damage
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What Is The Home Iv Antibiotic Service
In hospital, you may have been started on intravenous antibiotics to treat an infection. You may be well enough to go home before your course of IV antibiotics is finished. Many hospitals offer an intravenous antibiotics at home service which lets you finish your antibiotic treatment safely at home. Each hospital may have a different name for the home IV antibiotics service. This may be OPIVA , OPAT or HITH . The home IV antibiotic service is made up of infectious disease doctors, specialist nurses and pharmacists. In the community, there are district nurses who can help with the service.
Administering Antibiotic Therapy At Home
20 September, 2001By NT Contributor
VOL: 97, ISSUE: 38, PAGE NO: 62
JENNIFER DEAGLE, SRN, is a sister, hospital at home services, Southampton General Hospital
It is established practice in the UK to treat patients with chronic illnesses requiring intravenous antibiotics at home. Many patients with cystic fibrosis or cytomegalovirus have learnt how to mix and administer drugs while monitoring their own condition and caring for infusion lines .
In the USA outpatient therapy at home has become a standard mode of therapy for severe localised and systemic infections . The guidelines for an OPAT service recommend that a senior microbiologist should supervise the service, with the referring surgeon or physician retaining clinical responsibility. A nurse experienced in OPAT care should give the first dose of antibiotic and oversee the treatment, with pharmacy support. The physician, microbiologist and OPAT nurse should review the patient on a regular basis. If administration of care is passed to a second provider they must meet the same standards in delivering and monitoring care as the initial OPAT provider, with an OPAT trained nurse involved in the transfer of care. The treatment outcomes must be as good as those for patients treated in hospital .
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Picc Line Dressing Change
Your healthcare provider will give you directions on how to change the dressing on your PICC line. Generally, you’ll want to ensure good hygiene to keep the process as sterile as possible. Then:
- Prepare your sterile supplies, including gloves and antiseptic site cleaners.
- Change the dressing as often as recommended, more if it gets wet or dirty.
- Remove the dressing carefully, keeping the catheter in place.
- Inspect the site for any changes that suggest infection, like an odor or swelling.
- Apply and secure the new dressing after ensuring the site is clean.
What Is A Picc Line And Why Do Patients Need It
Theres no question that frequent needle sticks either for medication or blood draws can be inconvenient.
Its perfectly understandable if a patient becomes reluctant especially if the treatment is expected to last for a few weeks or months.
One of the options available as an alternative for such would be the use of a Peripherally Inserted Central Catheter, otherwise known as a PICC line.
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What Is So Special About A Picc Insertion At Hss
PICC insertion procedures are performed by HSS radiologists and qualified and specially trained radiology nurses, radiology physician assistants and radiology nurse practitioners trained to safely use ionizing radiation, and interventional vascular procedures.
To ensure safe and accurate PICC placement, PICC lines are inserted using either ultrasound or fluoroscopic imaging guidance. The final position of the PICC is confirmed by the radiologist on a chest obtained at the time of the procedure. When leaving HSS, the patient is provided with an information book, phone number and a pager number for contact to address any questions or concerns about the PICC.
The PICC lines commonly used at HSS has a patented Groshong valve, which offers an advantage of not requiring a blood thinner to be mixed with the saline flushes. PICC catheters come in single lumen or double lumen types.