I have a question, that was presented to me and I am not quite sure how to answer so I thought I would come to this great forum and seek some expert opinions. A physician asked me what to do if and when a patient refuses to allow for their picc line to be removed after completion of therapy. We discussed all of the potential worst outcomes such as infection and in worse case scenarios, IV drug abuse at home by the patient etc. and felt that this would have to be strongly conveyed to the patients. We also felt that proper chart documentation stating all risks were discussed with the patient should be done. If the patient still refuses, what would you do. It's actually a part of their body and I don't think we have the right to force them to have it removed. What legal issues should we be prepared for? I know this is a worse case scenario and the MD didn't actually say he has a patient that refuses to have their picc line removed, but I did have one home health agency call me and state the patient refused line removal. At that point, they are not under the hospital care any more and I really didn't know what to tell her. I appreciate your input.
I think you would have to treat each patient differently and learn why they did not want the catheter removed. Have they had numerous courses with repeated insertions and are not sure that therapy is truly over? Are they a very difficult stick and want it left just in case they need something in the distant future? You would have to educate the patient about why all catheters need to be removed as soon as therapy is finished and the risk to them if it is not removed promptly. Your documentation is the key to any legal issue. If you can not prove that you did something through your documentation, then there will always be a huge question of what and how something was done in any legal case. So document everything that you did and said, and the patient also. Provide information to them in writing and have them sign it and retain a copy for your records.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Ann Zonderman, BSN, JD, CRNI, LHRM
I did have a trained home care patient who refused to have her PICC removed. We had documentation of drug abuse via the line, consultation with her physicians (one a GI doc - for the discontinued TPN, and other - a psychiatrist who cared for her pain control, pain med drug abuse) When I spoke to the Docs, they were not aware how much IV Rx she was using. we had lenghtly discussions, the GI doc told the patient she had to see him, she kept cancelling appts, but he kept renewing RX. (ativan and phenegran, some morphine, were her choice drugs ) Neither doc would take proactive movemet to tell the patient she had to have the line out... my hands were tied... But they fully agreed the patient did not need the line... so we had to wait until she developed a line problem, occlusion or infecction... she was told to go to the ER for treatment. The home infusion company notified her she would not have nursing visits. Our pharmacists had to wait till the active prescriptions were expired. We even talked to the insurance folks,,, it was a very touchy situation.
CASE by CASE issue... and also as Lynn recommended, we documented every interaction, call and dispensing. The patient was indeed very angry with me for even suggesting the line come out... No further details... I left the job...
moral of the story.... Do act as an advocate, and document everything...
Ann Zonderman, BSN, JD, CRNI