I have been asked by an ID doctor at the hospital I work at if there is any type of locking device that goes on a PICC line to prevent misuse of a line in a pt for instance, that has history of IVDU. The common practice in most if not all facilities is to have the patient remain inpt or go to a SNF to receive IV ABX which, in some case could be up to 6wks or longer. It would be nice (and more cost effective) if there was something to be applied to the line that safe gaurds againt misuse so, the patient could come in daily as an outpt, recevie their doses and continue to be monitored on a daily basis but not have to stay inpt. Does anyone know of any products?
I have never seen such a product. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Legally I believe you are treading on dangerous ground. If this pt. has a hx. of drug use you have to remember that addiction is a disease. If the pt's best option for treatment of an infection is a PICC and you do not provide that, that can be considered withholding treatment. IV drug abusers can often be engaged in treatment plans and you will have the most success by being open and respectful and avoiding moralistic judgements. Would you withhold a PICC from a pig farmer because the job puts them at higher risk of infection?
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
I agree with Stephen's comments. You must provide the infusion therapy to your IVDU patients. You can educate and monitor. There are also signed contracts between patient and providers in situations such as this. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
The main problem is that is it not safe to send a patient home with a PICC line if the have history of IVDU. The patient is not with held treatment. The patient ends up staying in the hospital or going to a SNF which is very costly. I do not believe that it is safe to send a petient home having direct access to the vein and ease of use when they go home. No doctor at this hospital will send a patient home with a PICC due to the liability they would have and the home infusion companies that I have worked for do not accept patients onto service that have recent history of IVDU.
Brooke Thompson
The safety issue is the judgment call of your facility and physicians. There are many other facilities, physicians, and home care companies that do not have the same issues. So the cost of care in hospital or an SNF is related to the decisions made by your physicians. How many patients do you have in this group? I don't think there would be enough IVDU with a need for long term IV therapy and a CVAD in the entire country that would allow a manufacturer to justify making a product that was suggested in your original post. Besides, such a product would still require having a nurse visit the patient in the home for each dose to unlock this device. So I doubt that any home care company would accept this either as there would be nonreimbursed visits. So I think your answer is to research the creative ways that other use to provide care to these patients in the home. I know others have made this work. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Brooklyn!!
Which I have to say is a great name! Please check with someone who has the initials J.D. after their name, I really think your facility has more liability in being prejudicial in your care of this difficult patient group than in treating them correctly. I have worked with addicts, contrary to popular belief many will listen to someone who has the right communication skills and is concerned about their health. Of course all groups have good and bad, but with all due respect I would not rely on your physicians when it comes to the legal aspects of your practice...maybe start with your risk management department, and then seek your own counsel. Good Luck!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
I concur that IVDU patients are often very complaint and can be safely treated at home. An initial assessment to determine compliance with a plan of care that includes medical and psychosocial issues can offer more info to assess the situation. It is likely an insurance case manager is also involved with such a referral and may also offer some insight into the clients reliability for not abusing the IV device. Certainly it does not matter whether it is a PICC, peripheral or any other VAD....
A contract for compliance, great education and any support of significant others can improve the safety for this therapy.
IVDA is not a clear reason to reject the case - but then perhaps your organization has a basic policy that they can not mannage this clientel.
A case management and physician team meeting (including the patient ) could be used to determine safety.
AZ with the JD.
Ann Zonderman, BSN, JD, CRNI
AZ with the JD.....Love it!!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Thank you all for your input it is much appreciated.
Brooke Thompson
Excuse my lack of knowledge, but what is a JD?
Thanks!
Ann Armstrong, RN
PICC Lines
MidMichigan Medical Center, Midland
JD= Juris Doctor (Law Degree)