PICC PLACEMENT ORDERS


  • Patient has a history of:
  • PRESCRIPTION FOR GENEVA WOODS INFUSION PHARMACY

  • Geneva Woods nurse to place Peripherally Inserted Central Catheter (PICC):


  • MARK ONE:
      • Lidocaine 1% intradermally as needed for patient discomfort during PICC insertion
      • Geneva Woods nurse to verify PICC tip location in superior vena cava (SVC) using Tip Confirmation System (TCS)
    • If unable to confirm PICC tip location in SVC using TCS, patient will be sent to his/her facility of choice for anoutpatient Single View Chest X-Ray for PICC tip verification
    • PICC is authorized for use once PICC tip placement in SVC is verified
    • If Geneva Woods nurse is unable to place PICC, the prescriber will be notified
    • Geneva Woods nurse to perform PICC wire exchanges as needed (full barrier precautions and sterile technique

    will be followed for all PICC exchanges)


  • PICC LINE CARE

    • PICC dressing change once weekly and as needed for compromised dressing per Geneva Woods Pharmacy protocol
    • Sodium Chloride 0.9% 10-mL flush to be used to flush PICC before and after medication administration
    • Heparin 10 units/mL 5-mL flush to be used to flush PICC after Sodium Chloride 0.9% flush following each medication administration
    • For double lumen PICC, flush the unused lumen with 10 mL Sodium Chloride 0.9% followed by 5 mL Heparin 10 units/mL
    once daily or as needed if blood is visible in the line
    • Alteplase 2 mg – instill into each occluded lumen of central line PRN and allow to dwell per manufacturer guidelines (2 refills)


  • Please fax completed form to Geneva Woods Infusion Pharmacy
    907.334.8587