I was called to a skilled nursing facility to replace a PICC line that had positive blood cultures drawn from the line and the ID doctor wanted it removed and replace. Patient is receiving TPN.
When I arrived, I saw that it was the Arrow CG+ PICC line, looking it up, I see that this PICC uses CHG that is chemically bonded intra and exta-luminal surfaces and says it gives protection up to 30 days. My questions is this, does anyone know the recommendation for this type of PICC with the situation I encountered? I assume this PICC still should of been pulled with the positive blood cultures, but is there a different protocol with this type of PICC since it does have the properties I listed? Just making sure. I did try to research it, and did not see anything about it.
I did replace the PICC on the other arm and removed the Arrow CG+, I do not typically place PICC's immediately with a positive cultre result, but the patient did need TPN and had no other option for nutrition. I did ask the facility if they were planning on culturing the PICC tip, and they said no. I battle with these type of facilities, they always want a PICC line placed with blood cultures pending, patient with fever, etc. They have very little knowledge about vascular access and a large amount of the time they are unwilling to take my advice. Would love to hear from anyone who places PICC etc. in these skilled nursing facilities and what your challenges are and how you have resolved them. I try all the time to educate the nurses.
Denise Doscher RN, VA-BC, CRNI