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teri stevenaon
PIV to PICC Guidewire exchange
Hello,  Does anyone out there do this procedure, and do you have any evidence based practice to support it?  We allow this technique if the IV was placed sterillly, and it is done within 24 hours of placement with ZERO infection rate.  We have been asked to provide evidence based practice for this procedure and have not been able to find anything in our literature searches.  I have spoken to others at conferences that say they use this practice.  It is not addressed in the INS standards of practice.   I can't see where it is any different from exchanging a PICC for a PICC and that can be done anytme.  It sometimes comes in handy when the cultures are not back yet so the length of therapy hasn't been determined yet, or if it is a late consult, then we can give tham an access for overnight and exchange to a PICC in the am.   Especially on an infant or child who may not have that many places for access, and it saves another stick!  Thanks for your input.  Our team is hoping to write a paper on this technique in the near future.   Teri Stevesnon, R.N., B.S.N., Akron Children's hospital, Ohio
For the insertion of that

For the insertion of that PIV, are you using maximal barriers, the same level of skin antisepsis as you would with a regular PICC insertion, etc? What exact sterile procedures are being used to place that PIV? If it is the same exactly as what you are using with a PICC, then this exchange might be possible. But if not, I do not think it is a wise practice. An if you are going to that level for a PIV, why not just go ahead with the PICC at that same time? Childrens hospitals are exempt from the new CMS rulings about no more reimbursement for hospital-acquired CRBSI. But you might have private insurance payers that are not paying for these infections. I am not aware of any published studies on outcomes with this practice. 


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Gwen Irwin
You really need to publish

You really need to publish your procedure and the outcomes, especially with zero infection rate associated with this procedure. 

Gwen Irwin


My question to you are

My question to you are below:

1. Are you working with peds patients, if so why dont you just place a temporary IV, mark some site on the hands/arms,upper arms OR saphenous for neonates and infants and save it for your picc use.  MRSA is ver common now, and when our kids come in (admitted from ER) they usually have an IV and we usually just wait for bld cx results and then we start recommending PICCs/CVL/midline depending what kind of abx the patient will be receiving/length of therapy/pH & Osm of drug, etc....

2. Once cultures had been resulted then you can determine from there if PICC is still needed.

3. I would be more concerned with you CRBSI even if you say the your infection rate is low to none using this technique.

4. Does your hospital have P/P in regards to this. Will they back you up in the event your line gets infected and some major legal problem arises from this.  PLUS check the INS standard.

I personally have not done or seen this teachnique

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