Recently an overwire exchange was completed on a peds patient through an AC PIV. My concern is that the initial PIV was not placed with maximal sterile barrier and the exchange was done through this existing PIV. Anyone have thoughts on this process. I have read through the INS Standards, IV. Catheter Exchange, not seeing anything related to PIV overwire exchange.
My question would be: WHY??? Why would one think this is acceptable? I PICC is a central IV catheter and should be placed using maximum barriers and a sterile technique. Is that what the exchange was, for a PICC?
Yes, the exchange was for a PICC. I spoke with the ordering physician and primary RN, they both told me that they have seen this done many times on peds patients. They place an AC piv (not under sterile technique) and use this piv for an overwire exchange for picc placement.
I have also seen and heard of this being done in peds but it is not an acceptable method, ever. There is nothing in the INS Standards because there is no evidence for or against. You are correct about technique differences. This is not a practice that should be done at all IMHO.
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
Thank you Lynn for your response. I just became aware of this practice today, I had not heard of it before. I am wondering how to approach this with our peds Dr.s and nurses since there is no evidence for or against. It definitely does not seem like best practice, but the physician is stating he does it all the time.
Educate them about the maximum barriers and strict aspectic technique necessary for PICC insertion, plus the CVAD checklist that should be completed by an observer to ensure all infection prevention steps are followed. That should be plenty of evidence that this is not a safe practice. 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
Would you be willing to send me a copy of the CVAD check list.
You can find numerous examples by doing a Google search. CDC, IHI sites have them also.
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
Thank you!