The other day there was a gentleman brought to our ER for an evaluation of a PICC that had "migrated out 2 inches" at a local nursing home. When I saw him we had an x-ray showing the PICC tip in the upper SCV. He had only a gauze bandage over the site, and he had the worst case of contact dermititis that I have seen, presumably from theÂ transparent dressings that theyÂ had been usingÂ It took 2 chloropreps just to clean the area around the site and remove the drainage that was sitcking his hairs together. There was pus draining from the PICC site itself. We did, of course remove the PICC and culture the drainage. The ER doc was not fond of the idea of placing another PICC, and I wasn't sure that was a good idea to do that right awayÂ either. The plan was to send him back, do the next few doses (Vancomycin) in a PIV, and send him back to the ordering hospital for another line once we were sure he wasn't going to be septic from the infected PICC. What happened is that he was taken to another hospital that afternoon and a PICC placed in the other arm. They had not been able to place a PIV.
So my decision not to push the doc into ordering a PICC placement has been questioned. Any thoughts from anyone would be appreciated.