I was called to a skilled nursing facility to replace a PICC line that had positive blood cultures drawn from the line and the ID doctor wanted it removed and replace. Patient is receiving TPN.
When I arrived, I saw that it was the Arrow CG+ PICC line, looking it up, I see that this PICC uses CHG that is chemically bonded intra and exta-luminal surfaces and says it gives protection up to 30 days. My questions is this, does anyone know the recommendation for this type of PICC with the situation I encountered? I assume this PICC still should of been pulled with the positive blood cultures, but is there a different protocol with this type of PICC since it does have the properties I listed? Just making sure. I did try to research it, and did not see anything about it.
I did replace the PICC on the other arm and removed the Arrow CG+, I do not typically place PICC's immediately with a positive cultre result, but the patient did need TPN and had no other option for nutrition. I did ask the facility if they were planning on culturing the PICC tip, and they said no. I battle with these type of facilities, they always want a PICC line placed with blood cultures pending, patient with fever, etc. They have very little knowledge about vascular access and a large amount of the time they are unwilling to take my advice. Would love to hear from anyone who places PICC etc. in these skilled nursing facilities and what your challenges are and how you have resolved them. I try all the time to educate the nurses.
Thank you,
Denise Doscher RN, VA-BC, CRNI
PICCsmart
There are no recommendations, guidelines, or standards calling for negative blood cultures before insertion of any CVAD, which includes a PICC. So place the line most appropriate for the patient's needs. How long was this PICC in place? Were these cultures drawn peripherally, through the PICC or both? Both is the recommended diagnostic method for CRBSI. The sample from the CVAD indicates CRBSI if it turns positive 2 hours or less before the sample from the peripheral vein. The lab needs to be able to perform differential time to positivity testing. If not, the colony count from the catheter sample that is 3 times greater than the peripheral sample indicates CRBSI. Fever alone is not a valid reason to remove a CVAD. These cultures need to be done first before the line is sacrificed. There is no different protocol for an antimicrobial catheter versus one without these properties.
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