REcently we had a request to exchange a PICC following a code because the MD stated it was "no longer clean". Is this a common practice?? thanks for your help.
I have never heard of it. In the first place, a PICC's internal segments must be sterile, not just "clean". How long had this PICC been in place? Was it then and is it now still functioning properly? During the code was there many times that syringes were attached without proper cleaning of the needleless connector? If it had been in for a while (time for this change is unknown), and there was concern about contamination during the code, then I could see putting in a new one. But exchange through a contaminated PICC may not improve the situation. Exchange is not regarded as a means to decrease infection risk, according to CDC. If this was a relatively new PICC and it was and is functioning well, I would not have exchanged it nor would I have inserted a new one and removed this one. I would request that this physician provide you with more evidence to support this practice in the future. Then you must consider the patient's veins. Do they have good enough access to insert at a new site? But exchange is not the answer if the PICC is contaminated. Lynn
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
The dressing was actually removed and the PICC manipulated as it was not functioning, then en patient was transferred to MICU where all involved knew that the PICC had been compromised. Taht was FRiday, on Monday we were called to exchange. We placed a new PICC in a new site on the left, old PICC still in. I would love some reall rationale behind the practice of exchanges and new starts in these kinds of cases instead of "just do it because the MD wants it". Infection control said to go ahead and replace as well. Patient has no s&s and PICC position was confirmed at the cavo-atrial junction. The only documentation of the whole thing was exxternal length changed, which we wer told, "piccs are migratory". any comments are appreciated.
Cheryl E. Aldo, RN, BS VA-BC
The Infusion Nursing Standards of Practice has a standard on VAD exchanges with a list of applicable references used to create the standard. That is where you should start to learn more about this. For many years, CDC guidelines have stated that exchange should not be regarded as a means to reduce the risk of infection. If you suspect a BSI and do an exchange, you must culture the catheter, follow those cultures and remove the new PICC if thoses cultures are positive. The reason for this is that you have just inserted a guidewire through a VAD that is colonized with some type of organism(s). You have also inserted that new VAD through the colonized fibrin sheath that may still be partially intact. So the new VAD must be removed. Exchange is primarily used for catheter damage such as a broken hub or ruptured catheter, and not for infection control reasons. Lynn