Occluded PICC Removed with Client Shadowing – Nurse Clinicians in Action – 49

Occluded PICC Removed with Client Shadowing describes how a patient in a Hospice center had a PICC line that was being used for pain management, but it was no longer working, so the facility ordered a Midline to provide vascular access for the needed therapies. The occluded PICC line had to be removed, and the local staff showed interest and desire to learn and watch the removal procedure.

Occluded PICC Removed with Client Shadowing

– Clinical Case

A provider in a Hospice center contacted Vascular Wellness to have a Midline placed in a patient who needed vascular access for pain management. The Vascular Wellness nurse clinician arrived at the patient’s room a short while later and learned that the patient had an existing PICC line in the right upper extremity, but it was no longer working, so the facility had ordered the Midline to regain vascular access for the needed therapies.

During the Vascular Wellness nurse’s comprehensive review of the medical history, physical, and visual patient assessment, she determined via ultrasound that the existing PICC line was completely occluded. Additionally, the nurse confirmed that based on the medicines prescribed, the ordered Midline was a clinically appropriate and less invasive replacement vascular access device than a PICC line.

Occluded PICC Removed with Client Shadowing

– Diagnosis and Treatment

The clinician placed the Midline in the left arm without difficulty, and upon completion, she asked the patient’s nurse if the facility would like her to remove the occluded PICC line. The bedside nurse at first said no, and then changed her mind and asked the clinician to come talk with her and the nurse manager at the nurses’ station. The Vascular Wellness nurse cleaned up after the procedure and then joined the hospice center nurses. They explained that they had only removed PICC lines in deceased patients and asked if it would be ok for them to gather their nursing team to observe while the clinician removed the line. The Vascular Wellness nurse readily agreed and said that she would be happy to have them watch and essentially, shadow.

Before removing the patient’s occluded PICC line, however, the facility asked if the nurse could take care of two more patient orders for vascular access that had just been sent in. The Vascular Wellness nurse said of course and took care of the other patients who needed access for pain management. When she finished charting, she returned to the nurses’ station and checked in with the nurse manager.

The nurse manager at the hospice center said they were ready for the removal, and she and five other nurses joined the Vascular Wellness nurse in the patient’s room to remove the occluded PICC line. The vascular access clinician talked the nursing team through each step of her process and explained why each step was necessary (e.g., mitigating the risk of infection, how to prevent air embolisms). She also demonstrated and reinforced proper care, maintenance, and flushing techniques for existing vascular access lines.

The hospice staff asked many good questions throughout the process and were very excited and thankful to be able to see how to safely remove a PICC line. They also shared how thankful they were that the Vascular Wellness nurse was there and able to place all their additional vascular access lines in the same visit and so quickly, and they asked the clinician to enjoy some cake and candy they had on hand. The staff also asked how they could leave a great review for the nurse and for Vascular Wellness. The nurse shared how to leave a review, but the nurse manager also insisted on receiving the email address for the clinician’s manager so she could send a message and ensure she was called out for being such a great help with both the placement of lines as well as with education.

The Vascular Wellness nurse felt she didn’t do anything special or different from what she does every day, and she was so happy to be able to help patients and provide some vascular access education. The hospice nursing team was so grateful for not just the services, but the fact that Vascular Wellness clinicians are always willing and happy to spend the extra time with the patients and staff, versus being rushed off to the next procedure.

Within 12 hours, the vascular access nurses’ manager received an email from the Director of Nursing of the hospice facility sharing how impressed they were with the clinician’s caring, patient-centric approach and her willingness to perform the add-on procedures as well as help educate their staff. The facility always feels like it is one of Vascular Wellness’ most important clients, which is greatly appreciated.

Learn More about Air Embolism by reading this article: Air Embolism Causes, Prevention, and Management

Occluded PICC Removed with Client Shadowing | Vascular Access Specialists 

– Key Points

Unlike others who provide mobile services – especially those who pay nurses on a pay per procedure model that creates an incentive for speed and placement of the highest nurse-paying lines – our hospital credentialed Vascular Access Board Certified nurses are Vascular Access Specialists who are trained to take all the time needed before beginning every procedure or leaving the bedside or facility. Vascular Wellness nurses perform a comprehensive medical history review and complete a thorough physical and visual patient assessment to help ensure the most clinically appropriate line is ordered and placed. They also spend as much time as needed to talk with the patient and family to answer all questions and address any concerns before they begin. Through this comprehensive training and focus on the patient and client versus getting to the next procedure, our clients and patients get superior quality, information, and understanding at the bedside derived from the hundreds of thousands of lines placed since inception. Even though teaching and educating the staff during the PICC removal meant more time at the bedside and client, it was the right thing to do and represents the extra service that Vascular Wellness regularly provides at no additional charge.

We’re proud to regularly help Hospice Centers and their patients receive comprehensive, empathetic, and compassionate care at the bedside, and to provide comfort for the patient and their family and friends. Comfort is an essential factor we consider and take into account when recommending the clinically appropriate vascular access device. Even though predictions of life expectancy may be short, we still perform a comprehensive medical review to make sure the patient and medical team understand the vascular access device options. This is extremely important as some devices are more invasive than others, and this must be a consideration, no matter the benefit.

Serving patients at a Hospice Center or at their home is not new to us, and we are honored to be a valuable, experienced, and trained provider on holistic care. Our partnership with Hospice facilities as well as At Home patients enable us to bring high quality care to patients wherever they are most comfortable, and to extend and add to that comfort as much as possible.

Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician, as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA (Health Insurance Portability and Accountability) compliant communication app. In addition, our extensive training program and diverse client base, including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities, provide our clinicians with a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.

If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, Oklahoma, South Carolina, and Virginia; and
(2) Customized vascular access services to Arkansas, Delaware, Georgia, Mississippi, Pennsylvania, Tennessee, and West Virginia; and
(3) Support vascular access services to Ohio and Kentucky.