Pt with recent hx of thrombectomy x2 and revision of axillary femoral to femoral bypass X2 on right. Presently has d/l PICC left arm functioning well but MD wants fresh line for TPN.
1)Does vascular surgery of this type preclude use of the right arm for PICC insertion?
2)Does your facility require fresh central lines for TPN infusions?
I believe this surgery is on the arterial system and you would be inserting your picc line into the venous system. As to replacing of the picc line--I don't know that there's any literature supporting changing the line when initiating TPN. How old is the present picc line? I suspect that his line of reasoning might be that there could be biofilm buildup on the present catheter and with the high dextrose content of the TPN, there could be a increased chance of the line becoming infected sooner. Doesn't strike me as totally unreasonable especially if the present line is old.
Our vascular access team changes all the picc dressings throughout the hospital and with the excep
I don't think this arterial surgery would be an absolute contraindication, but a relative one. So if I could find some other way, I would prefer to avoid using any of the vessels on that arm. I also know that there is not any literature stating that TPN must be started into a new or "virgin" line. This concept has been around for a while, but no evidence to support it in the literature. With that being said, I also can understand the rationale - old PICC with biofilm and the increased risk of CRBSI when TPN is added. If the current PICC must be replaced, what about a tunneled cuffed catheter? 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