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Angela Williams
Contract for active drug-users/PICC's

Could someone e-mail me a copy of a contract used when placing a PICC for IV antibiotics in a patient currently using drugs?Of course the patient says he will not use line for recreational drugs, but I wonder if a contract would show that we addressed this with him prior to discharge , advised him of risks, etc


Angie, If a patient is a


If a patient is a known IV drug user, they will not be discharged home with any kind of access.  Usually, this patient is discharged to a nursing home for the duration of IV antibiotic treatment so that they can be supervised.  The other options are, of course, PO meds and for one of our patients, who did not want to go to a nursing home and needed IV over PO - she came into our medical unit and was stuck every day for the duration of her treatment. 

That's just how we deal with the situation when it arises.


3636 PICCs
What else is done in other hospitals?

Hi Kelly and all.

I just did a search on this issue since it is coming up more frequently for our PICC team.  Usually our procedure is what you have outlined however we have had at least one very serious complication recently. 

In the past I worked in home infusion and can understand the contract that is outlined in this thread, however if the patient was actively using drugs we would have to withdraw from the case due to staff safety and patient (non-compliance) once a plan was in place.  By the time it gets to that, the patient would have already broken any agreement or rights and responsibilities in place.

What does everyone else do out there?

Thank you.

Michael Johnson
Kaiser Foundation Health
Kaiser Foundation Health Plan, Inc.900 Kiely BoulevardSanta Clara, California  95051-53861(800) 464-4000 San Francisco French Campus Outpatient Home IV ProgramIntravenous Drug User Release for Outpatient IV Medication Administration I, ________________________, understand that I will be discharges from the hospital and will receive intravenous medication at (circle one):   home   skilled nursing facility   infusion clinic through a catheter (line in my vein) that has been placed for this purpose.  I have had a chance to discuss this with my doctor, __________________________________. I understand that the catheter is to be used only for prescribed medication and flushes. I understand that there are risks associated with unauthorized use of the catheter including infection of the catheter, bloodstream infection, introduction of air into the line (whish can travel through the vein into the heart and cause death), clotting or other blockage of the catheter.  There may be other problems, not listed here but related to using the catheter for injection of non-approved drugs, which could lead to serious complications including death. I agree not to use the catheter fro any purpose other than to administer prescribed medication and flushes for maintenance.  I understand there are life-threatening consequences of IV  drug use and specifically agree to abstain from using recreational IV drugs through this catheter intended to treat my other serious medical condition.  I agree to comply with any recreational drug testing that may be prescribed by my treating physicians. I will be given a copy of this agreement for my records. I have had an opportunity to discuss this form with my doctor and to ask questions, including why I am being asked to sign this form. Date of CDRP consultation: ___________  with __________________________ Patient agrees to CDRP plan:       yes         no Signed: ______________________________       Date: _____________________ Witness: _______________________________   Date: _____________________  
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