If he has positive BC I would wait until they are negative if possible and then place PICC. We give TPN peripherally although I hate to see it done and try to get PICCs in these patients. Is it possible to postpone TPN until cultures are negative? Obviously, he would need antibiotics which likely can be given peripherally for the short term.
Certainly it is best to wait for a negative culture, however the circumstances with each patient must be weighed. Generally the patient can't afford to miss several days of TPN. I would NEVER give TPN through a peripheral line. The pH and osmolarity of the TPN could cause BIG problems peripherally. I would consider asking the MD to place an IJ central line as a temporary measure to give the TPN, wait for the clear cultures, then place the PICC as it is a longer term line, assuming the patient is going to be getting TPN for a while yet.
This really depends upon what is going on with the patient. Some MDs like to administer antibiotics for 24 hours and then place a CVC for the TPN. Unfortunately,some patients cannot wait and we place the line as soon as possible for the TPN as well as other medications. We rarely use percutaneously placed chest lines anymore for TPN,we use mostly PICCS. Anything greater than 12.5 % Glucose (some hospitals have 10% as their cut-off) must be given in a central vessel (distal SVC).
There is no evidenced based literature to give you an answer. Is that not sad. It is all anecdotal. I have no idea if one should wait or one should place the line.
I can anecdotally tell you this. Whatever device you put into this bacteremic patient will form a fibrin sheath around it. If the bacteria is going to seed the catheter it will seed a peripheral, central etc no matter what you place. When you pull that catheter that fibrin stays in the vasculature with any seeding no matter what device you place. That than leads to the quesion what will waiting do as the peripheral you place will leave a fibrin sheath that may or may not be seeded. The antibiotics and the right ones are the key as that is to prevent or reduce seeding on the sheath.
I wish I had an evidenced based answer and not some anecdotal comments to provide as this question has never been answered and likely will never be answered. Clinicians learn from each other and there is no evidence in that communication transmission.
Bottom line there is no evidence to support 24, 48 hours or the number of negative cultures. And does that patient not need that nutrition to build strength to fight the organism. Why wait??? There is no proof to show waiting makes a difference.
This really depends upon what is going on with the patient. Some MDs like to administer antibiotics for 24 hours and then place a CVC for the TPN. Unfortunately,some patients cannot wait and we place the line as soon as possible for the TPN as well as other medications. We rarely use percutaneously placed chest lines anymore for TPN,we use mostly PICCS. Anything greater than 12.5 % Glucose (some hospitals have 10% as their cut-off) must be given in a central vessel (distal SVC).
Kathy Kokotis
Bard Access Systems
There is no evidenced based literature to give you an answer. Is that not sad. It is all anecdotal. I have no idea if one should wait or one should place the line.
I can anecdotally tell you this. Whatever device you put into this bacteremic patient will form a fibrin sheath around it. If the bacteria is going to seed the catheter it will seed a peripheral, central etc no matter what you place. When you pull that catheter that fibrin stays in the vasculature with any seeding no matter what device you place. That than leads to the quesion what will waiting do as the peripheral you place will leave a fibrin sheath that may or may not be seeded. The antibiotics and the right ones are the key as that is to prevent or reduce seeding on the sheath.
I wish I had an evidenced based answer and not some anecdotal comments to provide as this question has never been answered and likely will never be answered. Clinicians learn from each other and there is no evidence in that communication transmission.
Bottom line there is no evidence to support 24, 48 hours or the number of negative cultures. And does that patient not need that nutrition to build strength to fight the organism. Why wait??? There is no proof to show waiting makes a difference.
Kathy
Kathy Kokotis
Bard Access Systems