Can anyone provide documentation/evidence regarding why NOT to place a PICC in a patient that is septic?
We have this discussion all the time. We don't really have studies to indicate practice, but have several Infectious Disease doctors that want the PICC placed after 24-48 hours before PICC insertion. If that isn't possible, at least get some of the antibiotic doses in before the PICC.
Their point of view is if the PICC is placed it will be "seeded" and need to be removed and replaced after 48 hours.
Would love to see studies about this.
The concept of one infection seeding the catheter is the least common cause of CRBSI. Use these guidelines to know when to put in another catheter:
Mermel, L., B. Farr, R. Sherertz, I. Raad, N. O'Grady, J. Harris, and D. Craven, 2001, Guidelines for the management of intravascular catheter-related infections: Journal of Infusion Nursing, v. 24, p. 180-205.
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
Bard Access Systems
It seems I am stupid and need an answer to this that no one in any infection control position has been able to answer
If one suspects a catheter infection and that catheter should and does have a fibrin sheath, possibly fibrin tail - where does that seeded sheath go? To my knowledge it stays in the patient or goes to the lungs. Am I mistaken here? So the exchange or replacement of a catheter or waiting some magic who knows what number set by who knows whom, what does that achieve?
I think and have always thought that antibiotics are the answer and the right antibiiotics are the answer. I cannot understand waiting to place a PICC line in a bacteremic or septic patient as the drugs get infused on time in full doses if the RN is doing their job with a reliable device.
Biofilm formed from organisms on the skin or introduced through the hub are the most frequent causes of CRBSI. Next is infusates as the source. Last is the movement of organisms from one infected site to the catheter.
You are correct that any fibrin sheath/biofilm combination will shear off as the catheter is removed and it gets absorbed by the body. There is no indication in the literature that a fibrin sheath without full thrombus poses a threat of pulmonary embolus.
The guidelines I listed discuss the catheter replacement based on the type of catheter, the infecting organism and the acuity of the patient. There is no simple answer that applies to every situation.
Lynn you missed the point I am not concerned about the air embolism I am concerned about the fibrin sheath that is seeded aka biofilm that now stays. What is the point of removing a suspected catheter or not placing a line in a bacteremic / septic patient. This is all anecdotal stuff doctors have come up with as we have always done it this way. There is no research to base these opinions on. That is the problem.
I did not miss your point. I am saying that the IDSA guidelines I referenced in a previous message in this thread had information about the steps to manage patients with a bloodstream infection. The timing of placing a subsequent catheter is broken down in that document by the type of catheter, the infecting organism, and the patient's acuity. Read that set of guidelines.