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Vascular Access Placement Criteria

 

Patients will be assessed by the vascular access RN to determine the most appropriate vascular

access method.

 

Indicators used for assessment:

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APPROPRIATE FOR PICC LINE PLACEMENT

  • Chemotherapy

  • TPN

  • Supra Therapeutic INR

  • Morbid Obesity (especially when jugular vein access not an option)

  • Frequent administration of blood products

  • Long term IV medications (>5 days in hospital)

  • Planned home administration of IV medications (long term IV antibiotics)

  • CVP measurements in patient without existing central line

  • Vasopressors (Dopamine, Dobutrex, Vasopressin, etc.)

  • Sclerosing IV medications pH < 5 or > 9 (Concentrated Vancomycin, Diprivan, Mannitol, etc.)

  • Unable to obtain PIV after attempt with ultrasound by Vascular Access RN (VAT Nurse)

  • Frequent blood draws (i.e., every 4 hours for multiple days)


 

APPROPRIATE FOR PIV or Long Dwell Peripheral IV (Peripheral IV placement instead of PICC)

  • IV fluids

  • CT scan

  • Non sclerosing drips for short-term use (PCA’s, Insulin, Lasix, etc)

  • Non sclerosing antibiotics for hospital stay (Gentamycin, Flagyl, etc)

  • Short term access for stay < 5 days

  • Cardiac Catheterization

  • Failed PIV attempt by pt’s RN (must call PICC RN to try before a PICC is considered)

  • Confused patient who pulls out PIVs (a PICC is not the answer to this problem but the potential start of a bigger problem if the patient pulls the PICC out)

  • Long Dwell PIV: May dwell UP TO 29 days, Power Injectable for CT scans, ideal for longer hospital

  • stays (expected LOS 3 or more days), and FDA approved for lab draws.


 

APPROPRIATE FOR TUNNELED PICC PLACEMENT

  • As requested by patient’s nephrologist to preserve UE vasculature for future fistula sites (all patients with a serum creatinine above 2.5 or with renal history will be assessed with the nephrologist before placement in the arm)

  • Lack of access points in either arm (evaluation by Vascular Access RN)

  • Bilateral Mastectomy (w/Lymph node removal/biopsy) (OK to place on side if NO nodes taken)

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