In my data of over 1000 PICC line insertions, I am seeing the brachial vein overrepresented when it comes to CLABSI.  Has any one else experienced this?  I discourage the use of this vein for multiple reasons, yet it seems that this is the case.

Genine Schwinge, ANP-BC, Vascular Access Coordinator  Port Jefferson, NY

Sounds like a topic for a poster

This sounds like a great topic for a poster presentation and/or an article.  The actual data would be great to look at.

 

Tim

Genine, You may be seeing an

Genine,

You may be seeing an increase in infection with brachial piccs due to the multi-layered facsia one has to puncture through. Inflamation of this facsia may be the leading cause of infections.  Which vein you choose, 1) the branch to the basilic or 2) the branch to the axillary. Which one is the line being placed in? A good study.

PH

Paul Howell

If you are seeing increased

If you are seeing increased infection with brachial vein PICC's, here is something else to think about.  Traditionally, either of the brachials are smaller than the basilic.  If you are placing PICC's in this vessel and it is small, you may have a silent thrombosis.  This is important because there is a documented relationship between infection and thrombosis when it comes to CRI's.

Cheryl Kelley RN BSN, VA-BC
Independent Vascular Access Consultant

CLABSI and vein selection

I would ask how many days after the insertion does the CLABSI occur.

We don't see that as a trend.  We do an evaluation of every CLABSI, looking at location of the site, CVC type, and number of days after insertion.  We also examine the care and maintenance documentation, as well as flushes documentation, sluggishness vs. patency documentation, and dressing intact each day.  Add to that line necessity.

 

Gwen Irwin

Austin, Texas

To add to Lynn's great

To add to Lynn's great list....# of sticks to accomplish procedure?

Are you saying that the

Are you saying that the brachial vein sites are more commonly associated with CLABSI than the basilic or cephalic veins? If so, I woiuld look at the actual number of total insertions into the brachial vein. This should be the choice of last resort when basilic or cephalic can not be used. Who is placing your PICCs - nurses at bedside or radiologist? Are the inserters new to using ultrasound? Are you certain that these episodes of CLABSI are related to the insertion procedure by occuring early in the dwell time of the catheter? If occurring after a week, this is more likely caused by intraluminal contamination and has nothing to do with insertion technique or site. Just a few ideas to get you started on your investigation. 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