Hi all,
  I seek your input on rewiring a PICC that has been  broken (non-repairable)  or is leaking from the insertion site. Under what circumstanses would you rewire a PICC that is  broken or leaking from the insertion site?  Or, under what circumstances would you choose not to rewire?
  Or, do you have  other approachs to deal with the broken or leaking PICC?
Thanks for your input.
Sharon Kohler, RN
Brigham and Women's Hospital
Boston, MA
Hello Sharon,
We perform PICC exchanges in our facility on both Groshong and open ended catheters. We only do exchanges when there are no signs or symptoms of infection; elevated white counts, positive blood cultures and or fever. We also look at the insertion site to see if it is red, swollen or has drainage from the site. If the site looks good and no signs and symptoms of infection we exchange the catheter. With an unrepairable picc if leaking or broken, they only recourse is to exchange or replace. It is easier to exchange the catheter as access is already established.
Sincerely,
Nancy Riley, RN, CRNI
I would not rewire through a PICC that has been broken and leaking around the insertion site because it may already be contaminated.
However, I would exchange a PICC line that has not shown any sign of infection or complication to increase the lumen size when the patient's medical condition changes requiring more lumens and there are no other veins available to attempt a new site, or I would exchange a brand new PICC when its tip is only located in the innominate vein rather than in the SVC on the chest x-ray confirmation.
Just last week we asked Bard (Paul Blackburn) their opinion of over-the-wire exchanges. As the manufacturer of Bard catheters, they would not recommend over-the-wire exchanges because you may dislodge a clot, or a septic emlobi into the general circulation. Their recommendation is for through-the-introducer exchange only.
Regards
Dianne Sim RN
CEO & President,
IV Assist, Inc
Dianne Sim RN, VA-BC, CEO; IV Assist, Inc.
Should not have pressed the post button yet!!!
We would do a catheter exchange for an irrepairable line only if the site were absolutely pristine and the patient had no other veins eligible for fresh insertion.
In the case of leaking from the site, with no apparent hole in your PICC, you can't determine the pathology causing the leak. It could be a DVT causing a retrograde flow and hence should NOT be exchanged.
Dianne Sim RN
CEO & President,
IV Assist, Inc
Dianne Sim RN, VA-BC, CEO; IV Assist, Inc.