Hello everyone,

Bear in mind I'm writing this as I wait for the CXR on, YET AGAIN, another displaced PICC line. The frustration is mounting. I am a member of a 4 person Venous Access Service at a tertiary/ teaching center. Even though displacement may be an inherent risk of central venous acceess, I feel our rates are disproportionally high (8/72 last month, 4/30 to date). Is anyone aware of national benchmarks pertaining to dislodgement frequency ? We mandate a Patient Safety Report be generated each time a PICC is inadvenrtently pulled. We are tracking & trending but I am not aware of a resource for comparison. Has anyone else experienced dislodgement problems and how did you solve them ? Thanks for your help.

DB

I would also check with your

I would also check with your staff to make sure they are applying the statlock correctly.  Many people forget to apply the skin prep before the statlock.  Or maybe they arn't letting the skin prep dry completely before applying the statlock.

 These two things may seem minor but if done properlly can make the PICC much more secure.

 Another strategy may be to tape the tubing to the arn below the dressing.  In this case the tranporteres or other staff will feel resistance before any preassure is put on the PICC.

 

Thanks,

 Mike Brazunas

Clinical specialist

AngioDynamics.

We definitely have

We definitely have those....though I believe the numbers are way down with catheter securement (we use STATLock also).  A couple of years ago we had a lovely (seriously) and kind gentleman who kept removing his PICC line.  Even with a patient attendant there, he was so slick no one ever saw him do it.  One of the PICCs was never found.  The MDs kept reordering the PICCs - we finally had to refuse to replace until they/we came up with a better solution for this patient.  We named a manuever for PICC removal after this patient.

It would be interesting to keep track.  Anecdotally, most of our problems relate to transport and other uninformed personnel repositioning patients - stepping on the IV tubing, etc.  Even the OR has pulled them out when transferring patient from the guerney.  Not sure what the solution is.  Somehow the puller-outers need to be more affected by their lack of attention.  In addition to informing those culprits and educating them, it would be interesting to keep a public (hospital only) tally, like on your own vascular access website, of who removed the most catheters.  And/or - whoever pulled the catheter out has to come watch another PICC being placed in that patient.

I think even more than accidental dislodgements, we have 'dislodgements' from residents wanting to yank PICC lines prematurely! We're working on that one too.

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RN VA-BC
Nurse Educator IV Therapy/Vascular Access Fletcher Allen Health Care

Mari, Sorry, probably could

Mari,

Sorry, probably could have explained a bit better. By dislodgement, basically, I mean the  UN-intentional removal of all or part of the catheter from the insertion site. We've seen the confused patient who, despite having a sitter at the bedside, wrangles the PICC around his pinky, the post op CABG who is being mobilized, gets grabbed under the arm and the PICC gets yanked. Patient movement, staff inattentiveness and a general complacency regarding the management of these central lines seems to be pervasive. We do use STATLock devices and the majority of time they provide adequate securement. We have seen, especially in one unit where early mobility is a goal, the wings "pop open" with tension applied to the line. (Did I mention inattentiveness ?) Do we need to add yet another poster above the bed screaming "I HAVE A PICC LINE" ???

Thanks for listening :) 

DB

David Bruce RN

Vascular Access Service

Albany Medical Center, Albany NY

What kind of dislodgements?

What kind of dislodgements?  The entire catheter has migrated out?  The tip migrated somewhere other than optimal location?

Do you use catheter securement devices? 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RN VA-BC
Nurse Educator IV Therapy/Vascular Access Fletcher Allen Health Care