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Thu, 09/27/2007 - 00:32

awallace

Wire left in

I recently placed a PICC in a pt in the late afternoon and forgot to pull the wire. It was left overnight, being removed at ~0800 the following day. It was a 5fr dual lumen Graoshong PICC and that port was not used all noc. Does anyone have any data on an increased rate of infections for pt's who have had the wire left in?

Also, I do not have u/s (It is in the budget for next year) so I have to start an IV before I can place a PICC. We had a VERYÂ hard iv start, and it took me and another 30+year nurse 20 sticks to start an IV.Â After we started the IV, I created my sterile field, cleaned the hubÂ of the catheter with cloraprep after removing the "dirty" items, keeping everything sterile, changed my gloves again, and attempted to thread the wire. I couldn't get a PICC in, but my question is Does starting the iv before getting sterile compromise the pt at all with re: to infection?

Â I have spoken with the wonderful person who trained me and she assures meÂ that it's happened before and though not ideal, it is not a 'huge' risk. As far asÂ starting theÂ IV, she said it is anÂ acceptable practice. Â Thank you so much. AnnaMarie

Thu, 09/27/2007 - 12:06

lynncrni

I disagree with your

I disagree with your instructor. Inserting a PICC through a PIV inserted with clean no-touch technique instead of sterile technique with maximum barriers is far less than the national standard. While we can never make the skin sterile, a sterile prep does greatly reduce the organisms on the skin. A prep for a PIV is not as thorough or as large. So I believe the patient is at a greater risk for catheter related infection.

Regarding the wire left in, I would not be so much concerned about infection as I would be worred about increased risk of thrombosis. This would depend upon how active the patient was and how much they used the arm while the wire was still in place. Lynn

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

Thu, 09/27/2007 - 15:28

(Reply to #2) #3

awallace

I don't think I made myself

I don't think I made myself clear; After cleaning the site, I did get the entire site sterile. Is not the inside of the catheter sterile? I cleaned everything with the cloraprep before creating the sterile field, and of course, after creating the field. She was an extrememly hard IV start which is why I felt it necessary to start the IV first. I did want to open a PICC tray if I couldn't get the IV started.

Tue, 10/02/2007 - 13:07

(Reply to #3) #4

lynncrni

Was your original skin

Was your original skin preparation for the PIV insertion performed with sterile technique, including sterile gloves, using chlorhexidine in an area large enough for PICC insertion? If so, there should be no problem. However if your initial skin prep used only clean gloves in a small area typical of a PIV insertion, that was not sufficient for a PICC insertion. Lynn