Case Study 1

Successful bedside placement saves Interventional Radiology costs and increases the chance of early discharge from hospital.

CASE: A 24 year-old Hispanic female admitted on a Thursday evening with dehydration and weight loss. She is in her 10th week of pregnancy. This is her second admission for hyperemesis in the last 10 days. On Friday morning the decision was made to start her on TPN. A PICC was ordered for TPN administration. Her English-speaking ability is limited, and an interpreter was called in to explain the procedure and help with obtaining consent. The hospital IV team attempted the PICC placement in the late afternoon after consent was obtained.

The line placement was not successful. Interventional Radiology had left for the day and would not do PICC placements on evenings or weekends. If a PICC or other central access was not placed prior to Monday, discharge would not take place until Tuesday or later. A 24-hour trial of the TPN was planned prior to discharge.

CONCLUSION: PICC STAT was called at 5:30 p.m. on Friday. PICC was placed and confirmed by 8:30pm. TPN was started Friday evening and the patient was discharged Sunday morning. TPN was started on the day it was ordered and two days of hospitalization were saved.