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sschwarz
Prevention of CLABSI in the home

We provide home infusion and most of our patients have PICC lines.  This weekend our on-call nurse got notified that a pediatric patient lost their needlefree connector off the end of the PICC line.  The family was not at home and did not have IV supplies with them.  Is anyone aware of any protocol or study that outlines the steps to take in this occurrence in order to prevent a line infection?

lynncrni
Nothing that I have ever seen

Nothing that I have ever seen published. Also infection is the least for my worries. Venous air embolism is the primary immediate risk. Was this line clamped? I certainly hope so as air can easily enter any CVAD lumen including a PICC. On admission to your service, there should be written instrutions for the family about how to immediately clamp this extension leg by folding it over and taping if there was no other clamp. Then I would scrub the female hub of the catheter and let it dry and then attach a new needleless connector. Then notify the physician about the possible risk of intraluminal contamination. But if this PICC had been in place for several weeks, there is already significant intraluminal biofilm already growing. 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

mary777
We provide  written

We provide  written instructions to all our home care patients with CVADs on the steps to take should this occur. In addition to the written instructions I review with them the steps to take should this exact incident occur. I instruct them to make a small kit to take with them that that includes a needleless connector, alcohol pads,a CVAD dsg change kit, a rubber band or two and a few 2 x 2s and some flushes. Children are very busy and playful so it's important that they have a kit with them on outings. A rubber band can always be used and the tails of any CVAD can be folded over and tied off with a rubber band if it is an open ended non-valved catheter. If it has clamps it should be immediately clamped.  If there is no cap readily available a bandaid can be used or anything clean to prevent any further exposure. 

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