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Removing PICC lines for infections

In the INS Core Curriculum for Infusion Nursing by Mary Alexander, there is information on page 95 regarding removing PICC's for infections. It states exceptions for catheter removal include the presence of Candida or other fungal infections.  Does anyone know the rational behind this????  Recently we had a patient test positive for yeast from the blood drawn from the picc, but negative from blood drawn from the arm.  The PICC tip was negative.  The patient had yeast in his respiratory system, but not the same type.  The patient also had yeast in the urine, but no culture was done for the type. Furthermore, the patient was on TPN and multiple antibiotics. I was upset that they blamed the infection on the PICC line and made us remove it. I have read this exception for removal before, but do not understand the rational so I can explain to the doctors that I do not have to remove a PICC for the presence of Candida???? Does anyone know the rational????

First, I would regard the

First, I would regard the Core Curriculum information on CRBSI as being outdated since there has been so much else published since this book. It is quite possible to have a + catheter blood culture, negative blood and cath tip culture. This would tell me that the catheter is colonized with growing biofilm on the intraluminal surfaces due to the management of the catheter hub. PN supports the growth of candida easily!! There is some times when one can attempt to salvage a catheter with antibiotic lock techniques but this depends upon many variables. That may be what you are referring to. Here is the most recent set of guidelines:

1.    Mermel LA, Allon M, Bouza E, et al. Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2009;49(1):1-45.


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

Removal of PICC

Thanks for information Lynn.   :())

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