We are interested in how other hospitals are handling placement of PICCs on patients with pending blood cultures. We know it is best to wait for negative blood cultures, however we have some Intensivists that are insisting on PICC placement in patients that have a clinical picture of sepsis with pending blood cultures. If you have any policies/guidelines or EBP to share that supports waiting, we would love to see them. Thank you in advance!
Aileen Rogers RN VA-BC
406-657-4798
n
I am curious about what evidence you used to write your policy. Please share. 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
Here's a study I kept from 2012:
J Vasc Interv Radiol. 2012 Jan;23(1):123-5. doi: 10.1016/j.jvir.2011.09.024.
How long should peripherally inserted central catheterization be delayed in the context of recently documented bloodstream infection?
Sam
n
Wow, back up a minute! I did not say I disagreed with you, at least until you got to the common sense comment. The goal these days is evidence based practice and that is what I asked for. In the absence of evidence, each facility has to look at staff, pateint, and facility factors and make the decision they think is best. That does not mean that we can or should leave it at common sense. Identifying holes in the evidence and pursuing studies to close those holes should be everyone's goal. 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
n
We might be saying the same things. Common sense could mean that your hospital took a careful look at all factors and wrote a reasonable policy for all CVAD placement in the presence of a positive blood culture. But in some places it could also mean that we based our policy for PICCs only on what we learned 20 years ago in nursing/medical school and did not look at any evidence or consider anything other than what our beliefs have been for many years. Two different approaches. Even though our direct question may not be answered by a specific study, there are others that would impact this decision. As Jill said, not all organisms are the same. Also hemotagenous seeding is the lowest rate of all 4 causes of CRBSI. Are you using the CLABSI definition or the CRBSI definition? What happens to the VA needs while you are waiting for the cultures to clear? Couldn't a short PIV or midline have similar risk as a CVAD for seeding - all are plastic tubes in the bloodstream? 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
n
That is what I was hoping your would say for the approach taken at your facility. From my perspective, I can easily see some hospials taking the opposite way - this is what I have known for years and the way we have always done it - those facilities that do not put emphasis on evidence based practice. So this discussion has been good to highlight the differences. I have seen some P & P that would curl your hair!! 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
Aileen, you raise a great discussion. Not everything will "seed" a picc. Candida sure can, your IP folks can help sort the bugs for you but with cultures pending, you don't always know what you're dealing with anyway. If you have a pretty good idea what the pathogens are that can help direct the decision.
This might need to be case specific in order to consider the vascular status of the patient. Look at options right now today, what might be needed tomorrow, and for the rest of the course of therapy. I personally don't think we can write an absolute policy on this yet with the devices currently available. This is of course, my opinion.
n