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Patient refuses PICC removal

Just curious if anyone in home infusion/home care has ever had a pt refuse to have PICC removed?  We have to discharge this pt today (was notified by certified letter) because her MD is discharging her (major non-compliance).  She has burned every bridge in town and no MD will see her.  We did just get the order to remove the PICC but I have a feeling she is going to refuse.  I advised our nurse that it the pt refuses she must sign our discharge form stating that she refuses.  Any other suggestions?  Thanks!

Marianne Valentine, RN, BSN, CRNI



Well, (just curious) what

Well, (just curious) what happened?  Did the patient refuse D/C of the PICC?  If so, what did you do?

Rivka Livni PICC RN We have

Rivka Livni PICC RN

We have had many AWOL with PICC, both from in- patients and out-patients settings. Some come back very sick with bacteremia and endocarditis, some get arrested for some infractions and we hear from the jail about them, and I am sure some die of overdose, but we have not established contact with the city coroner office.

When a patient does show up and we need to remove the PICC we can call institutional Police when they arrive, and with the presence of the police we remove the PICC. (we do not tell them that we are calling the police)

We have a list of patients who are repeat offenders and they enter a list of "NO MORE PICC FOR THIS PATIENT" which goes on their medical alert file in the computer, so that as soon as their file is being accessed by any provider they can see the medical alert. The alert is accompanied with our pager and phone number, so any provider can get in touch with us, if they want details.

What ever the situation is, whether we were able to remove the PICC or not, we make sure we document in details what has occurred and what we did about it. 

The non compliant patient is a great challenge for any PICC team, documenting your instructions to them (pre and post insertion) and the teaching you did plus communicating this to their primary provider will be able to guide everyone to make decisions that will be safer for this type of patient.

Good luck. 

Rivka Livni PICC RN

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