patient has a picc in the right arm that is pulled back by 10cm and now in the subclavian vein. MD wants the picc pulled and replaced with a new one. The left arm is not an option.
How long after pulling the right arm picc is it ok to replace the picc from an infection risk standpoint and how far from the current site should the new insertion site be? I can't seem to find any literature regarding this issue.
I have never seen any evidence that gets to that level of nitty gritty detail. Is the current PICC infected? Exit site or bloodstream? If current one is in basilic, use the cephalic or brachial. But it does not sound like you have a confirmed infection at this point. Can you do an overwire exchange?
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 reply. The existing picc has been in place for 3 weeks. Is there not an increased risk of BSI with OTWE and don't the current standard of practice suggest placing a picc on intact skin? Is an existing picc, when removed, now considered "non intact" skin? How far away should a new picc be placed from the existing non intact skin?
Yes, there is a risk of infection with an overwire exchange. Your judgement is what leads the decision making about whether this risk of less than or more than the benefits. A search of the INS SOP for "intact skin" does not bring up anything related to PICC insertion with t his phrase. It will take a while for an old PICC insertion site to heal but if needed you could use other veins in that upper arm for a new PICC insertion. eg if in the basilic, use cephalic.
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
I guess Lynn the other question I have is when only one arm is an option and there is an existing infiltrated, phlebitic piv in that upper arm, where do I place a picc for this patient?
Assess the integrity of the veins where complications occurred and make a judgment about their use. This is based on your judgment. If that arm is not usable, then you will need to go to a low IJ site then a mid thigh femoral.
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 so much. I appreciate your expertise.
BR