I'd like some guidance or 'experience sharing' for what to do if a PICC in the community (HOME CARE) does not give blood returns?
I am in total agreement with practice standards that all CVC's should give blood returns prior to the administration of drugs and solutions. I am in agreement that all CVCs that do not provide brisk returns should be investigated. The Home IV patients pose a different challenge than our acute care patients. Currently, when nurses are unable to get blood returns they have a protocol that includes calling nurses in the Acute care setting. These nurses are skilled inÂ line assessment and the use ofÂ Cath-Flo. They have expertise based on their high volume of PICCs where as the Home and Community Nurses in more rural areas often do not.
The issue is a lack of resources in our smaller communities. We would like to prepare decision making guideline for the Community nurses: what to do when they are unable to get blood returns. This would include assessment and tips but utimately support their decision to restart the infusion or cap the line andÂ delay treatment (not my favorite choice!) The time of the greatest challenge is when our resources are at their lowest (ie.on a Friday afternoon or a weekend!) I do appreciate that the risk is the same anytime!!! However, the reality of addressing it during these times causes undo hardship to our patients.
In Home and Community clientsÂ onÂ pumps haveÂ continuous flow infusions (mainly Antibiotics)Â and only have the line checked for blood returns by a Community nurse with a tubing change every 4 days. If this day arrives on a Friday or a weekend and they are unable to get blood returns what should they do?
Does anyone have a protocol, experiences or advice regarding how best to address this issue with Home IV patients?
Laurie McCulloch, Nurse Clinician IV Therapy VIHA