Our IR docs change out PICCs with suspected line infections using an over wire technique and want us to do the same.  We always go to the other arm and do a fresh insertion.  But if they are blocked on that side or for some reason that side can't be used we refer to them.  However they want us to stop doing that and just change out the line.  What  are INS standards and/or best practice regarding this?

pull lines

I would do a culture of the blood from each lumen of the catheter as well as a peripheral blood draw before I removed the line to start with.  Studies indicate we are pulling 10% of PICC lines for suspected infection and they are not infected.  I would than take that data to a QI committee for re-vamped thought process change on pulling lines to begin with

Next if a liine is suspected it is not wise to exchange for multiple reasons one being that you leave a dirty sock when removing the line in the vein or pulmonary system somewhere.  You may be putting the new catheter right back into the dirty sock if it is infected.  Doubt it is infected to begin with

Next off you do not need to wait 24 hours that is anecdotal bull!!!!!!.  This is not an implanted or tunneled line.  The key is to get the antibiotics started immediately to fix the dirty sock. I would put a PICC in a different vein for sure if I did really suspect an infection and than run antibiotics immediately and I mean immediately.  You allready left all that biofilm and fibrin behind which is part of the problem if it is an extraluminal infection.  In the new sepsis protocol no one waits to start a central line for negative cultures anymore.  At least those practicing evidenced based sepsis bundle these days.  Not too many hospitals practicing sepsis bundles yet.  I am shocked by how much we lack in evidence based medicine daily.

Kathy Kokotis RN BS MBA

Bard Access Systems

I D S A G U I D E L I N E S 2009 Update

http://www.journals.uchicago.edu/doi/pdf/10.1086/599376

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

This set of guidelines was

This set of guidelines was originally written by the Infectious Disease Society of America and reprinted in the JIN. This document has been updated in 2009 but not yet reprinted in the JIN. Here is the most recent reference:

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

Lynn

 

 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

I agree that I would NOT do

I agree that I would NOT do an over the wire exchange in the scenario of a suspected line infection.  If the other arm is not available, would you recommend pulling the picc line and using a PIV for 48 hours and then replacing a new picc in the same arm at a different location than the previous picc line

 

Guidelines for the Management of Intravascular Catheter-Related

This article might be helpful for you?

It has information about when to remove central lines. If you look at the section about nontunneled catheters, that might be helpful for the PICC question. 

Journal of Intravenous Nursing:
May/June 2001 - Volume 24 - Issue 3 - pp 180-205
Guidelines for the Management of Intravascular Catheter-Related Infections
Mermel, Leonard A. DO, ScM; Farr, Barry M. MD, MSc; Sherertz, Robert J. MD; Raad, Issam I. MD; O'Grady, Naomi MD; Harris, JoAnn S. MD; Craven, Donald E. MD

 

suspected line infections

Thanks Lynn,  I really appreciate your response.  I will speak with our IR docs about this.

CDC Guidelines "Use a

CDC Guidelines "Use a guidewire exhcange to replace a malfunctioning nontunneled catheter if no evidence of infection is present." You are correct to not exchange these catheters with suspected infection. If there is a reason why the other arm can not be used for a new PICC, another type of catheter at a different insertion site should be chosen. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861