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windstrings
Change picc and culture tip and replace with new.....

I've seen this order many times.... some feel they should never place a picc in someone who has positive blood cultures, but to rather place an IV until cultures are negative and only then place the new picc.

Others feel its ok to place the picc as long as you pull the first one before installing the second one so as to prevent the tips from making contact.

If the infection was localized to only the tip.. that would make perfect sense to me.. .but if its systemic... the whole blood system is infected so I don't see the point.

 

Others feel its no big deal to install one while the other is present "so as to avoid a period of not having a line", and to simply pull the suspected infected picc once the new one is in place.

 

IN the past, I've heard its easy for bacteria to "seed" to the new picc when the new picc is introduced into an infected environment causing the life of the new picc to be short lived as it will surely become infected too.... yet other infectious disease doctors don't seem to have concern for this issue and downplay its revelancy.

 

Then other doctors don't worry so much about blood cultures but rather "has the patient already been on antibiotics for a few days" implying the presence of antibiotics in the blood system would prevent any possible "seeding" to the new.

Does anybody have any credible standards of practice for such situations?

lynncrni
Yes, it is thoroughly

Yes, it is thoroughly outlined in the following document and is based on the acuity of the patient and what is cultured from the catheter. Find this document to address your questions:

1.    Mermel L, Farr B, Sherertz R, et al. Guidelines for the management of intravascular catheter-related infections. Journal of Infusion Nursing. 2001;24(3):180-205.

This is a set of guidelines published by the Infectious Disease Society of America. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

windstrings
Sorry I'm not as versed with

Sorry I'm not as versed with this forum as you may think I am, but I did not notice a link to the file you specified and when I googled it, I only came up with a page of which I had to register and it wanted Article/Content Price: USD$ 29.95

Is this the area you were guiding me to go?

http://www.journalofinfusionnursing.com

 

 

The second mouse gets the cheese!

windstrings
But when this order is

But when this order is given, its not known what "if any" organism it is as the culture of the old tip is often not even done till the new picc is already installed or just prior and it takes time to grow a culture.

Basically, the doctor is 'guessing" knowing that he will delay the  patients hospital stay if he waits for culture results.

Some it its ashamed as I've been ordered to place a picc on such a patient... just to have another doctor order it to be removed later in the day or the  next day not knowing that its a brand new picc.... but I guess thats another issue of poor communication. 

The second mouse gets the cheese!

lynncrni
What clinical signs or

What clinical signs or symptoms are presenting to make them give the order to pull the PICC? If it is fever alone, that is addressed in this set of guidelines. They can and should be doing blood cultures before pulling the line - this would be the national standard. Get this article and read it to see what I am talking about. Lynn 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Daphne Broadhurst
You can access the article,

You can access the article, free of charge, at:
http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/idsaivcath.pdf

 

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

windstrings
   Thanks

 

 Thanks Daphne....

 

______________________________

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The second mouse gets the cheese!

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