Does anybody out there have a hospital policy how to deal with IV Drug Users who AWOL w/ their PICC, some come back w/ CRBI and/or severe Celulitis of the arm, some we don't know what happened to them. The question is should they get another PICC when readmitted.
about 30-40% of our PICC insertions are either Heroine or Meth injectors. Some have AWOL w/ PICC more then once, few don't even wait for CXR confirmation of tip placement.
What are other institusions with this problems are doing with the ones who get re-admitted? Do you put another PICC?
Wow, 30-40% of your insertions are for IV drug abusers. Spooky. We try our best to not put a PICC in a IV drug abuser. If we do, we "consent them for safety" and tell them that they can not leave the floor without an hospital escort. Obviously, they can still leave, we can not watch them 24/7. But we never DC them home with a PICC, they have to stay in the hospital until their IV therapy is complete.
I have never had one leave with the PICC and then be re-admitted so I have no suggestions for you. Sorry. Good luck.
Lisa Y., Team Leader IV Team UPMC St. Margaret Pittsburgh
We try not to place PICCs in patients wiht active drug use. If we have to they are placed in a skilled nursing facility to recieve their meds. NEVER sent home w/ PICC.
Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy
Thank you for your responses.
As a public hospital, a large portion of our patients are active IVDU, we must treat them, MRSA Bacteremia and Endocarditis is rampant among them. They have no IV access when admitted so they get a PICC.
We also do not send them "home" (or most likely back to the street). We do admit them for the 2-6 weeks of Vancomycin into a skilled nursing facility. We do not discharge them w/ PICC. They just AWOL on their own.
I do get a verbal agreement from them not to AWOL w/ PICC, and most do stay for their entire treatment.
The question is what to do with those who do AWOL then come back with serious problems, again they need long term abx, the physicians tell me I must insert another PICC regardless of their flight risk.
I would like to develop some hospital "guidelines" or policy regarding the ones who are continuing to AWOL over and over again. Does anyone out there has such policy or guidelines adressing this problem. Should I refuse to reinsert PICC in those patients who keep "re-ofending"?
Does anyone knows if we as nurses are allowed to refuse inserting PICC because the patient missbehaves and acts unsafe for himself? some may call it being judgemntal.
Any guidelines will be helpfull.
Risk management tell me I need to develop my own policy.
Some ideas come to mind. Substance abuse is a diagnosable condition with ICD-9 codes and all---if you and your MD's can agree that IV drug use as a diagnosis is a relative or absolute contraindication for PICC placement,you may be able to avoid that "refusal" word and not sound judgemental. I would also make sure there is adequate patient education available and documented as provided if you do give them a PICC,something that clearly spells out the risks. That is, "If you misuse this PICC,you may get a fatal infection that we may not be able to treat for lack of IV access." Just some thoughts....
is it even an option to call the police, have the patient brought in re: danger to self, and then d/c picc and allow patient to leave? or if the police want they can arrest?
I also have put piccs in known users, but fortunately have been able to either contract with the patient to stay, or convinced them that it wouldn't be good to leave with it. I have pulled them so they can leave though, despite still having an infection.
Lawrence Rojas RN
Radiology Dept.
Garden Park Medical Center
Gulfport, MS
Lawrence Rojas RN
Radiology Dept.
Garden Park Medical Center
Gulfport, MS
Thank you Lawrence for your comments.
The police is not an option, almost all the AWOL patients are homeless, no address. The police does bring them in if they get arrested and found to have a PICC. I had a talk with the Medical Examiner to try and see if he will notify us when an OD body is found with PICC in place to let us know, and he said they cannot do that.
Since I started doing the verbal contract with our active IVDU we have seen a drop in AWOL w/ PICC. I do tell them if they leave w/ PICC I will put them on the "PICC shit list", then place an alert on their electronic medical record (which is connected to all our city wide satelite clinics), so if they show up in one of those clinics the PICC gets removed.Those patients don't get another PICC inserted when they are readmitted.
Don't get me wrong, they still go AWOL, but now they get someone to remove the PICC before they leave. Those patients will get another PICC inserted when they get readmitted.
Wendy Erickson RN
Eau Claire WI
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
We are looking for patient education material for patients with a history of IV drug abuse explaining the risks of unauthorized use of a VAD and/or perhaps a waiver that patients sign.
Thank you for any help you can provide.
Daphne Broadhurst RN
Desjardins Pharmacy
Ottawa, ON
Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada
A bunch of years back we had an elderly confused man make his way out of the ER, unseen at night. He ended up on a near by highway...... and yep, you gussed it, he was hit and killed by a car. I think the family sued and the case was settled out of court. Hence the reason for 1:1
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.