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IN THIS ISSUE |
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Over the next year, several long-awaited transformations will take place in the UAB Hospital Department of Radiology. A recent addition to the Department is our new special procedures patient holding unit. Over the next year, two new replacement angiography suites, a new digital fluoroscopy room and a new special procedures reading room will be completed, vastly improving our technical and service capacity. Nearby, a new reception desk should be complete upon publication of this issue of Visions. The first phase of a major office relocation will begin in May. Most of the Radiology faculty offices and conference rooms will be relocated to the third floor of the North Wing, with completion of this move in the fall. Some interesting new computer-projection features are planned for our new main conference room shortly after its inauguration. Much of the space vacated on the sixth floor will be renovated for use by cardiology. In the late spring or early summer, a long overdue renovation of the inpatient film library area will begin. Upon completion, it will also house a new chest radiology reading room and a new bone reading room. Our hope is that by the time of completion, we will be performing primary interpretations of chest x-rays and some bone images from electronic imaging workstations in these rooms. One area of chronic embarrassment has been our cramped ultrasound service in the Hillman building, which requires patients to be frequently left in an open hallway. Because of the impending move of offices out of this area, ultrasound will be renovated to accommodate more appropriate waiting facilities and examination rooms. Currently, our physics, service and administrative support is housed in over one-half dozen locations scattered over several blocks of the medical center. If approved, all of these activities will eventually be consolidated on the third floor of the general services building. This newly occupied space will include a new opening directly from the connector attached to Deck 4. While we anticipate substantial disruption during these
construction projects, we also hope that they can sustain
our ability to provide professional service during the next
several years while we plan for more permanent solutions
through the strategic planning process. We are grateful for
your willingness to endure these inconveniences for the
benefit of our patients. |
FAQs - Frequently Asked Question
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Q: Peripherally Inserted Central Catheters (PICC lines) |
The Vascular and Interventional Radiology Section has extensive experience in the placement of venous access, especially in difficult patients. Recently, one of the most popular and commonly requested types of venous access is the Peripherally Inserted Central Catheter or "PICC" line. Many referring clinicians and services have questions about when PICC line placement is appropriate and how to request this service. The following questions and answers are intended to answer some of these questions and streamline the scheduling process. |
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Q: What is a PICC line? |
A PICC line is a specialized form of intravenous line. It is placed in a peripheral vein in the arm and threaded into the central circulation. The catheter tip may be left in the superior vena cava (a PICC line) or in the axillary vein (a "mid" line). The catheter can be placed either by a home health nurse on the floor, or a Radiologist in the Interventional Radiology Section. |
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Q: When is a PICC line placement appropriate? |
A PICC line is indicated for any patient who needs a catheter for short to intermediate term IV access and in whom repeated IV punctures are difficult or contraindicated. A PICC line can be left in place for up to 3 months and can be easily cared for by the patient or home health professional. Home antibiotic therapy and long term access in chronically ill patients (e.g. Post CVA) are two of the most commonly encountered indications. PICC lines can also be used for drawing blood. However, because of their small caliber, if they are not adequately flushed after each use, this will often cause catheter thrombosis. Infusion of blood products or TPN is usually best done through a larger bore subclavian or internal jugular catheter. If you are not sure which venous access is best, one of the interventional staff would be happy to discuss the various options with you. |
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Q: How is the catheter placed? |
The home health nurse places a PICC line much like any other IV line. When a patient is referred to the Radiology Department, we use ultrasound guidance to directly puncture a vein in the upper arm. Catheter tip position is confirmed fluoroscopically and the catheter is sutured in place. The catheter is then ready for immediate use. |
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Q: How can I request PICC line placement? |
The first step in any patient in whom a PICC line placement is required, should be a telephone call to Donna Fulton from The Visiting Nurse Association (870-3341 ext. 255). Because the VNA can place PICC lines on the floor at significantly lower cost, they should be consulted first. If the VNA is unable to place the line, then Interventional Radiology should be contacted at 4-0152 or 4-0153 and the procedure requested. We can usually place the catheter within 24 to 48 hours of the request. PICC lines are not considered an emergency procedure and therefore are not placed on weekends, holidays, or after hours. PICC lines can be placed while a patient is in the hospital or can be scheduled as an outpatient procedure. |
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Q: How should the catheter be cared for? |
The catheter should be covered with a sterile dressing that is changed every 2-3 days. The catheter should be flushed once a day and after each use with heparinized saline (100u/cc). |
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Q: How is the catheter removed? |
The catheter can be removed either by a home health professional, on the floor, or in a doctor's office. The sutures holding the catheter in place are clipped, the catheter is pulled, and pressure held over the exit site until hemostasis is obtained. If any problems or resistance to pulling is encountered, Interventional Radiology can be contacted for assistance 24 hours a day. |
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Q: What types of problems can be encountered? |
The two most common complications of PICC line placement are infection, usually local at the skin site, and catheter thrombosis. Both can be prevented by good care of the catheter after initial placement. Venous thrombosis around the catheter can also occur, but is rarely symptomatic. |
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Q: What if I or my patients, have further questions concerning PICC line placement or care? |
The Section of Vascular and Interventional Radiology has a pamphlet on PICC line placement and care, which is given to each patient at the time of catheter placement. Interested physicians or nurses can obtain a copy by calling our office at 5-4850. The Interventional Radiology physician and nursing staff are also available to answer any further questions. |
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Doctors Rachel Oser and Mark Gerscovich place an ultrasound guided venous access catheter. |
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Catheter being placed in internal jugular vein under ultrasound guidance. |
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Visions is published quarterly by the University of Alabama Hospital, Department of Radiology. Professor and Chairman: Robert J. Stanley, MD, Vice-Chairman for Operations and Academic Affairs: Robert E. Koehler, MD, Vice Chairman for Planning and Administration: Lincoln L. Berland, MD, Director of Outpatient Services: Peter Dempsey, MD. Visions Staff - Managing Editor: Pat Moore. Editors/Writers: Lincoln L. Berland, MD, Rachel Oser, MD, Robert Lopez, MD. Web Master: J. Kevin Smith, MD, PhD. Creative Services Staff - Editor: Jo Lynn Orr. Art Director: Jason Bickell. Please direct questions, comments, and suggestions as follows: Attention Angie French or Lincoln L. Berland, MD. Fax: 975-7213 Address: NHB 623B E-Mail lberland@uabmc.edu UAB Radiology Home Page: www.rad.uab.edu |