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Michelle Todd CRNI
Definition of PICCs being used or removed and whether PICCs can be maintained for blood draws.
My facility is a Long-term acute care hospital. This is basically med-surg. with trach vents, dialysis, wound infections, and chronic acute care. Almost everyone has a PICC line. I want to stick with the bundle recommendations and remove lines that are not being used. To me, this would mean they are not used for IV meds or labs for 96 hours. However, some people have different definitions of what "line being used" means. We have a physician who orders PICCs removed and a peripheral line placed if the patient is no longer getting IV meds. He does want peripheral IV access maintained and he commonly then orders labs every day or every other day. The patients have usually had their PICCs in for a couple weeks and have no problems and no erythema. The patients are long term and frequently have had prolonged hospitalization and pokes before coming to us and then have poor vein choices. They usually get several pokes each time the nurses rotate the site. Frequently, the nurses can not get labs on them so they draw from the PIV or several pokes are completed. Sometimes these peripheral lines are left in for over a week because the Doctor wants access and the staff can not get a new line to rotate the site. Sometimes the patients only need dialysis labs three times a week. Should a PICC be left in place just for IV access and lab draws? What if only lab draws are needed and they are only 3 times a week?..which could be a lot more than 3 pokes. Is this a good enough indication to meet the bundle recommendations? 
That depends on how you

That depends on how you apply the CDC language. "Promptly remove any intravascular catheter that is no longer essential." If you consider those PICCs to be essential for drawing blood samples, then I would allow them to remain in place. I would never remove a PICC and then place a PIV just because some physician wanted access. I am certain this also depends on who is using these catheters for blood draws. If a generalist staff nurse, they may easily contaminate the PICC due to hub manipulation and cause a BSI. Changes of a BSI from a PIV is far less and those complications would be limited to infiltration and phlebitis and failure to obtain the sample.  You have to make a risk vs benefit analysis for your patient population. 


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

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

G.G. Northington
My facility is pondering

My facility is pondering that same question.  I also work for a LTAC, and in May and so far this month, we have had 2 blood stream infections--that I believe was related to a PICC being left in place for the "just in case" reasoning and to draw lab work.  The patients then needed a new line and it has prolonged their stays for several weeks.

In the prior 8 months, we only had 1 BSI --and now one in May and one in June-and the month isn't even half way over!!!


Noland Hospital of Montgomery

Having dealt often with LTAC

Having dealt often with LTAC type patiets, I would recommend leaving the PICC in.  Not only are those types of patients horribe to get PIV's, They can be very difficult PICC insertions as well, they tend to have a lot of narrowing, scarring, thrombus, etc. So if you have a good line, keep it and educate, educate, educate on proper technique to avoid the CRBSI.

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