Letter to Dept. of Public Health, State of Connecticut

The following is a letter dated 6/15/2009 written to Diane Cybulski, RN, Supervising Nurse Consultant with the Department of Public Health in the State of CT.

Hello Diane:

Thank you for taking the time to speak with me on Tuesday, June 9th. My appeal is to allow the educated and trained Intravenous Nurse to place PICC lines in Long Term Care Facilities in Connecticut.

I have a concern when my Intravenous Nurses are requested to place a Midline for antibiotics that should correctly be administered through a central line with Superior Vena Cava (SVC) placement. A Midline is eight inches in length with the tip terminating in the axilliary basilic or cephalic vein. Because of the Ph, osmolarity or tonicity of the intravenous antibiotic in combination with the intravenous solution, the administration through a Midline presents a great risk of damage to the intimal wall as the medication enters the vein at that point.

Looking back 10 years ago, Midlines were adequate for intravenous antibiotics mostly because the rampage of MRSA, C-diff and VRE had not developed a foothold in our medical facilities including Long Term Care Facilities and any infections did not require the combination of intravenous antibiotics we are seeing ordered by physicians today.

As the bacterial, fungal and viral diseases have increased and spread, so has the strength of the antibiotics, sometimes two or three antibiotics in combination, placing our long term care residents at risk for phlebitis, thrombophlebitis, and/or cellulites when these combinations are administered through a Midline.

In essence, my concern is that without a definitive statement from the Department of Public Health in Connecticut regarding the consent to insert PICC lines in Long Term Care Facilities, intravenous antibiotics would continue to be ordered through a Midline.

In the state of Massachusetts, Intravenous Nurses are allowed to place PICC lines in all areas of patient care. This service reduces the cost to our long term care facilities in that the patient remains in the facility and is not required to leave the facility (sent out). The service also reduces patient discomfort and nursing time.

In conclusion, I trust that we will continue to communicate and develop this important topic. I can be reached by telephone at (800) 992-0027 or by email at ecurtin@infusionplus.com.

Regards,
Eve Curtin, RN, CRNI
President/Owner
Infusion Plus, Inc.


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Letter to Dept. of Public Health, State of Connecticut The following is a letter dated 6/15/2009 written to Diane Cybulski, RN, Supervising Nurse Consultant with the Department of Public Health in the State of CT. Hello Diane: Thank you for taking the time to speak with me on Tuesday, June 9th. My appeal is to allow the educated and trained Intravenous Nurse to place PICC lines in Long Term Care Facilities in Connecticut. I have a concern when my Intravenous Nurses are requested to place a Midline for antibiotics that should correctly be administered through a central line with Superior Vena Cava (SVC) placement. A Midline is eight inches in length with the tip terminating in the axilliary basilic or cephalic vein. Because of the Ph, osmolarity or tonicity of the intravenous antibiotic in combination with the intravenous solution, the administration through a Midline presents a great risk of damage to the intimal wall as the medication enters the vein at that point. Looking back 10 years ago, Midlines were adequate for intravenous antibiotics mostly because the rampage of MRSA, C-diff and VRE had not developed a foothold in our medical facilities including Long Term Care Facilities and any infections did not require the combination of intravenous antibiotics we are seeing ordered by physicians today. As the bacterial, fungal and viral diseases have increased and spread, so has the strength of the antibiotics, sometimes two or three antibiotics in combination, placing our long term care residents at risk for phlebitis, thrombophlebitis, and/or cellulites when these combinations are administered through a Midline. In essence, my concern is that without a definitive statement from the Department of Public Health in Connecticut regarding the consent to insert PICC lines in Long Term Care Facilities, intravenous antibiotics would continue to be ordered through a Midline. In the state of Massachusetts, Intravenous Nurses are allowed to place PICC lines in all areas of patient care. This service reduces the cost to our long term care facilities in that the patient remains in the facility and is not required to leave the facility (sent out). The service also reduces patient discomfort and nursing time. In conclusion, I trust that we will continue to communicate and develop this important topic. I can be reached by telephone at (800) 992-0027 or by email at ecurtin@infusionplus.com. Regards, Eve Curtin, RN, CRNI President/Owner Infusion Plus, Inc.