I was wondering what other PICC teams are doing in regards to pending blood cultures and placing PICC lines? I was told it is not recommended to place them becuase if the cultures are positive then seeding of bacteria on the line can form and possible infect the line. Also what do other teams do if PICC placement is requested for frequent blood draws or testing such as CT Scans? I was told at an INS meeting that most teams do not consider this a viable indication but I do not know what the next step would be. Thanks for any help!!
We do not place PICC lines with pending blood cultures. We wait 48 hrs to make sure that there is no growth. That is what the Infectious Disease MDs have recommended. If a doctor is insistent that a PICC be placed, then we ask them to consult with the Infectious Disease MD to ask if it seems reasonable or not to place a PICC. Most times the ID doctor says to wait. If the pt is going to require a long period of frequent blood draws and be in the hospital for some time, then yes we would likely place the picc. If the pt just needs a line for a CT scan, we place a piv via ultrasound if no one else is able to get an iv in.
I have just researched this issue in the literature. There are no firm recommendations about this and it depends upon the type of CVAD (percutaneous or surgically inserted), availability of other CVAD sites, and the specific organism cultured out. For Staphylococcus aureus, the blood culture should be negative before an new CVAD is inserted, but coag negative Staph means that a new line could be put in more quickly. The best resource on this is:
Mermel LA, Allon M, Bouza E, et al. Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter‚ÄêRelated Infection: 2009 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2009;49(1):1-45.
Here is a new study about this issue stating a very low rate of relapse of the bacteremia (o.9%, I think) but the rate of relapse is even less if you wait at least 3 days between culture results and PICC insertion
Daneman N, Downing M, Zagorski BM. How Long Should Peripherally Inserted Central Catheterization Be Delayed in the Context of Recently Documented Bloodstream Infection? Journal of Vascular and Interventional Radiology 2012;23:123-5.
Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Regarding your first question, there are antimicrobial PICC lines available, and these would be the best option for patients with pending blood cultures, suspected infections, in need of access. Many facilities wait 48 hours after cultrures are drawn and antibiotics started via PIV before placing a central line. This is a recommendation from SHEA.
Regarding placing a line for other than a long term infusion--that is where the expert vascular access nurse needs to step in, make an assessment of the patients needs and advocate for what is best for that patients. There are no black and white rules when it comes to patient care.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Chris, please post the reference from SHEA that you mentioned. I have never seen this statement from SHEA. Thanks, Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
My question is, I have just started working at a new facility the policy states, "for pending blood cultures, wait 48 hours prior to placement of PICC" however, a physician can insert another type of CVAD. Isn't this two different standards of practice?
Yes, it sounds that way to me. A PICC is a CVAD, so why can a physician insert a CVAD when the nurse can not in this 48 hours. Does not make any sense. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
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Our facility per the request of our ID physicians wait 72 hours with clear BC prior to placing a PICC line. Not to say that they ask us for placement prior. When we have placed prior to the 72 hour clearance and it pop's with growth, they want it changed within 12 hour. We have been very strict about the 72 hours. Their request and rule not ours. Saves the patient and us both.