Ok we have a new intensivist who started in our ICU. He is thinking that any Picc that a patient comes in with, particularly from a nursing home should be D/C'd because of this new thing that we will be responsible for our infections. So basically as a just in case. I do tend to think another reason though is that he is trying to train the residents on triple lumen subclavians. he as already had us pull piccs so he can place a triple. Any documentation out there? I think INS states change dressing and caps and x-ray, nothing about pulling without any sign of infection. Any feed back would be great. Thanks Susan
You could draw a blood culture from the PICC line,for a baseline, to see if anything is growing. If your hospital would allow it, perhaps you could do this on a number of patients, to establish whether the lines are being removed unnecessarily. I would also think some of the patients' labs would indicate if there is an infection brewing. I would not think it is in the patient's best interests to have the line removed solely for residents' practice! A lot depends on the patient's admitting diagnosis--if sepsis or infection is a question, then the blood cultures could establish a possible source, at which point you would want the line out. You would have some preliminary results in 24-48 hours. If the line is a problem, you may also see some temperature spiking within an hour or so of flushing it.
At our hospital, when someone comes in from a NH or another hospital with a PICC line, we get a chest x-ray to determine tip placement, replace caps and dressings, check for patency and blood returns, and look at the site and arm for problems. If everything is ok, the patient keeps the line.
Cindy Schrum RN CRNI
Cindy Schrum RN CRNI
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
To paraphrase a famous line from "The Graduate".....one word....."BRUSHING"
May be the practice of routine interluminal brushing could facilitate screening patients admitted to the hospital with a preexisting CVC--Much in the same way we now swab wounds and orifices for MRSA--This would address at least one of the 2008 CMS changes
Robbin George RN VA-BC
If we started endoluminal brushing of all catheters on patients admitted to the hospital, I would predicte that 100% would be positive and therefore in need of replacement. All catheters grow biofilm and the brushing technique removes the biofilm. The unknown question is when does the biofilm actually produce a bloodstream infection. We do not have a complete answer to that question yet. It could be related to the biofilm breaking loose and floating into the bloodstream. This could be caused by the brushing or flushing techniques. It could be related to normal mechanisms within the biofilm or to the decreased defense mechanisms of the patient. So I do not think that brushing all catheters present on admission will be beneficial. At least we need much more science to support this practice to be used for this purpose.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861