Please share your thoughts and advice on PICC placement while there is an existing CVC in place e.g. TLC, PA cath, infusion port etc. In a prior facility we didn't attempt routinely due to increased risks e.g. inability to pass PICC, intimal vessel damage, entanglement of lines, infection risk and thrombus. In current facility it is attempted.
We often place a PICC with an existing central line in place, often so that the central line can be removed. These patients are often ICU patients on multiple drips and need the access until the PICC is placed and confirmed. We have never had an complications (that I am aware of) and rarely encounter any difficulty passing the PICC. As with pacers, we place on contralateral side whenever possible.
The need for a second CVAD is based totally on the specific circumstances of each patient. Obviously if you can avoided it, that is best. But sometimes it can not be avoided due to the patient's needs. This requires a careful assessment and proper planning by an infusion specialist. More lines means more risk. So this requires a risk-benefit analysis. 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
Here's an article on this topic..just read it recently...
Scheithauer, S., Häfner, H., Schröder, J., Koch, A., Krizanovic, V., Nowicki, K., & ... Lemmen, S. W. (2013). Simultaneous placement of multiple central lines increases central line–associated bloodstream infection rates. American Journal Of Infection Control, 41(2), 113-117. doi:10.1016/ j.ajic.2012.02.034
Results showed CLABSI rates were significantly increased when 2 more more CLs were in place simultaneously. Their findings suggests that the current method for CLABSI surveillance should be modified to account for patients with multiple lines..resulting in a more precise prediction of risks.
Kevin
Kevin Arnold RN, MSN