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Lynn Davis
MD Anderson PICC care

Can someone from MD Anderson PICC team email me and explain why you are still suturing PICC lines instead of using a securement device? Also, I would like to know why home care patients are not using chloraprep and Biopatches. I see these patients at Seton in Austin when they are between treatments at MD Anderson.

Thanks,

Lynn Davis RN CRNI

Lynn Davis
Forgot to add my email
Forgot to add my email [email protected]
mary ann ferrannini
Hi Miss Lynn,  My
Hi Miss Lynn,  My experience with home care is that every time I want to use a Biopatch I have to beg for one for my homecare patients. This is true even for those patient populations (ie.CA, immunocomprimised) that will greatly benefit. I think in homecare its about the bucks. I also thought that Medicare and I think Medi-Cal will not pay for Chrohexidine for catheter care. I went to access a port on one of my chronic Medi-Cal patients and was abit suprised to find a Chloraprep wand. What is your state is doing...because this could be one of the reasons. Did you need that article we talked about? I did not check my E-mail had 21 PICC orders in 2 days!!!!
CherylFerraro
In Richmond VA, Radiology is
In Richmond VA, Radiology is suturing piccs in. The reason is because they are pulled out so often when they have used the stat lock. Also a stat lock comes in our picc kits but there are none available elsewhere. They should be changed qweek but there are none to replace them with. Radiology wants them sutured in.

Cheryl Ferraro, RN

JoseDelp
   Hello, Mentioning home

   Hello,

Mentioning home care has struck a chord with me. We seem to have the same problem with home care and nursing homes not having the stat locks for dressing changes. We have made approaches on these agencies to educate and encourage the use of stat locks and not had success in changing their practice. Meanwhile they increase the cost of healthcare by sending these patients in for "evaluation of the PICC Line" when they migrate out. They send them to our ED! Guess what the nursing home patients most often come by ambo. It makes you want to consider suturing because of cost..... I know, I know the real deal here is the preventions of PICC infections.    

Jose Delp RN BSN

Clinical Nurse Manager IV Team

Upper Chesapeake Health

Jose Delp RN BSN

CliClinical Nurse Manager IV Team

Upper Chesapeake Health

pjean
Just recently had a pt.

Just recently had a pt. return to the hospital that had a PICC inserted by our team and sent home on Home Health for PICC line care.  The Stat Lock had NO remaining foam, the only thing remaining were the "flaps" that secure to the PICC.  The whole thing was nasty.  Incredibly, the site looked great and the patient did not show any s/s of infection. (was readmitted for multiple blood transfusions).  I contacted the director of the home health agency who informed me that "Medicare does not pay for those Stat Lock things" and so we wouldn't absorb the cost of that item.  I'm quite sure, however, that they were receiving reimbursement for PICC line care and I am of the opinion that if a company accepts the patient with a PICC line ( and is therefore receiving revenue for it), they should be prepared to "care" for the line properly!!!!  It occurred to me the other day regarding the upcoming Medicare payment exclusions......suppose a patient has a line inserted and is then sent home with home health.....only to return with a CRBSI......do we as the hospital receive any reimbursement in that instance? 

momdogz
"....sent home with home

"....sent home with home health.....only to return with a CRBSI......do we as the hospital receive any reimbursement in that instance?"

The CMS rules state that costs associated with HAC (Hospital Acquired Conditions) will not be paid for by them.  A patient admitted WITH a CLABSI, acquired somewhere other than the hospital, is not a HOSPITAL ACQUIRED condition, so CMS would pay for the hospitals' treatment of that CLABSI.  That CLABSI would be coded, upon admission, as NOT being hospital acquired.

MDs/hospitals will be responsible for coding those events.  At this point, CMS will not be auditing that hospitals are coding HACs correctly.  It would be the responsibility of the MD to classify, with the admitting diagnosis. 

And...interesting to note, many hospitals have been moving toward this quality incentive measure for some time by not charging ANY patients for HAC, whether or not they are paid by CMS.

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

JoseDelp
 Kind of makes you want to

 Kind of makes you want to do screenings on each patient when they return to inpatient environment. Kind of like our MRSA screenings on all patients admitted from nursing homes is done now.

Jose Delp RN BSN

Clinical Nurse Manager IV Team

Upper Chesapeake Health

Jose Delp RN BSN

CliClinical Nurse Manager IV Team

Upper Chesapeake Health

momdogz
probably not a bad idea,

probably not a bad idea, Jose.  At the very least, great improvements should be made in nursing documentation of patients admitted with existing VADs. 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Lynn Davis
I did a month long project

I did a month long project on our Oncolgy floor ar Seton to find out that MD Oncology Out patient offices access ports without using sterile technique and alcohol. Lots of guaze under tegaderm also. I saw a home health patient with a 7 day dressing with guaze!!! The statlock was outside of the TSM.

It is interesting when best practice and research show that Biopatch,cloroprep and Statlok reduse CRBSI's! It is to bad it has come to profit over pt care!

gpspowell
It is interesting to read

It is interesting to read hospital-based RNs having the same issues with home-care agencies as we (Home Infusion) have with hospitals AND home-care agencies.  My nurses ALWAYS use sterile technique, retention devices ("Stat Lock" or "The Bone"), and Bio Patches.  I think the issue here is one of education.  Infusion Specialists are in a position to educate those in the healthcare industry that are delivering sub-standard care.  It's an uphill road but who is in a better position than we to take it on and make a difference?

 Mike B., Director of Nursing, Chartwell RMR, Denver, CO

Mike B., Director of Nursing, Chartwell RMR, Denver, CO

momdogz
Very true, Mike - good

Very true, Mike - good point.  And it does go both ways - or - in all directions.  Home care infusion specialists should also be assessing well and documenting those VADs that come from hospitals.

As a large teaching facility (30 patient care areas and 100 clinics/outreach services) we have a large reach, and responsibility I believe, in leading education efforts.

Our facility is in the process of coordinating the surveillance/education/networking part of our VAT with the home infusion companies, including our own home infusion pharmacy, and vendors in our area so that we can help each other maintain SOP, and communicate better.  We've got two large presentations/forums coming up in September and October for the region for starters, and we're creating a clinician DVD for central line care/maintenance.  We'll keep home infusion reps from the area on our quarterly VAT meetings to keep the networking and education alive.

 

The response from the beneficiaries so far has been one of relief; I think we're not the only ones that have recognized this deficit! 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

JoseDelp
 I wonder why the

 I wonder why the clinicians across the board who care for these lines don't have a stronger desire to learn the SOP. The infusion companies and clinics out there have a SOP and accrediting bodies to answer to. Do  we not all have standards and should we not all seek education? I am over worked educating and keeping the inpatient nurses on the right road. Who can help the outpatient areas? I know when I started I was and still d want to provide the best for my patients. I searched until I found the resources and educated myself and others as soon as I found what I needed.

Jose Delp RN BSN

Clinical Nurse Manager IV Team

Upper Chesapeake Health

Jose Delp RN BSN

CliClinical Nurse Manager IV Team

Upper Chesapeake Health

piccmasters
MD Anderson's central

MD Anderson's central lines/PICC lines are kept by patients for months to years (long term). Patient/ family does own care when sent home. Stat locks are not able to hold these lines secure enough. The statlocks are good for short term only. But for uniform teaching/ we have to suture them. It moves in and out each time the statlock is being changed. i use these in other hospital- even  trained nurses, still pulls the catheter out from the original site while changing the statlock. Some don't even change them, the foam are grossly hanging torn apart when we get them from other institution.

 

afruitloop
At my previous facility, the

At my previous facility, the home care agencies did not supply stat lock.  AFter replacing many PICC's due to migration, we played "hard-ball."  If the home care agency did not supply stat locks for securement, they did not get the PICC referral.  After only 1 month with our own institution's HH agency, they got stat locks.

It is a financial consideration for everyone and is as long as it is short.... no $ in HH for stat lock, but no consideration for the hospital finances (limited reimbursement) with repeated PICC placements.

Cheryl Kelley RN BSN, VA-BC

sparkyrn
For the Posting from

For the Posting from piccmasters, owner, picc masters  

I wonder if you are changing the StatLock with each dressing change. 

StatLocks are designed to stay in place no more than 7 days (per the mfr's recommendation).

If you would email me, I can give you resources to assist you!

Elizabeth.Lijewski[email protected]

piccmasters
we don't use

we don't use statlocks.Reason-no statlocks available to change weekly. Therefore, we suture all our central lines.

Statlocks need changing weekly or whenever its non-adherent due to other problems: i.e. bleeding.

I don't diagree the use of stalock if the central lines/ piccs are for short term use only, like, a week of use, otherwise, if you send the patient home with it, and they have to care for their PICCs, or subclavian lines, then suturing them in place is convenient for patients/family. One patient was so upset because she has to have another PICC inserted due to accidental pull out of her PICC with the use of statlock. haing Physical therapy- pull out. other personnel caring- not so careful with the care.

We have no infection from the sutures.

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