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Greg Scott
Order to replace PICC with new PICC when starting TPN

Good Morning,

I have an order to replace a picc that is 10 days old.  The rational for the replacement is the starting of TPN.  Is this done in other facilities.  Any comments are welcomed.

Greg Scott

I have never heard of this
I have never heard of this practice and do not understand the rationale if there is absoutely no problems associated with the PICC line. 
Jonathan Rolt
Our hosptial does require
Our hosptial does require it. TPN requires a deicated line so if it has been used at all we have to change it. We "try" to plan for it and label one as TPN only. I have had only one time where no other line could be placed and the medcial team allowed it to stay in.
As long as TIP

As long as TIP re-verification is done, and all new tubing is used (of course), we do NOT change the PICC. No need to put the patient through another PICC insertion if there are no problems with their current one.

Have had no complications or bad outcomes.

Raquel M. Hoag, CRNI

Raquel M. Hoag, BSN, RN, PHN, VA-BC

mary ann ferrannini
 Does the patient have an
 Does the patient have an unexplained temperature or elevated WBC count? We did have some MDs ordering this as well until we educated them. Some do not realize the many benefits of the PICC line and do not fully understand why they have a lower infection rate. We also explain to them how we use Maximal barrier precautions and how we provide all the dressing changes and cap changes. Perhaps they are thinking of them as a traditional CVC (IJ SUbclavian or Femerol). That is what some of our MDs thought Have you asked these MDs what their rational is so you can discuss this with them?
So would I be correct to
So would I be correct to surmise that any patient also receives a new subclavian or IJ approach central line as well in the instance that TPN is ordered after insertion?  Also for those that "replace" that totally new stick or over the wire exchange? 
Hi Greg! The practice in our

Hi Greg!

The practice in our facility usually involves - having CXR done to verify PICC tip placement, assessing insetion site( making sure that it is not infected- we do take site culture swab if we note any drainage, change the clave and dressing) and the docs usually order for blood culture from PICC before we dedicate a lumen for TPN. If the result from the blood culture turn out positive , the PICC have to be removed and will be replaced after repeat blood culture/s will be negative(after 48 or 72h). We also consider looking at pt's labs and temperature before inserting a new PICC

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