Just looking for more info on this topic. I understand Burn Units are very specialized and difficult to keep things black and white. I have been called to discuss issues with administration and the director of the Burn Unit or our Hospital to figure out how to make everyone 'happy'. A pt had 80% burns. Both arms were circumferentially burned, grafted and in the healing stages...with many scabbed open areas. The elbow had a burn/pressure sore. And a very large area of hypergranulation being treated with impregnated gauze. The right arm was excluded due to lymphedema. The basilic was inaccessible due to atrophied shoulder/clavicle and very limited joint movement. There was no visible brachial to access. The cephalic was located directly below the hypergranulation area. When the area was cleansed, the area started to ooze large amounts of serous drainage. As the consulting vascular access team and after discussion with the Burn PA it was decided that a PICC was not possible at this time. Pt currently had a TCL RT IJ placed in IR - that was at its max number of exchanges. I initiate a PIV for the pt. When attending came in next day - he was very angry at the fact that no PICC line was placed. The burn attending wants us to 'bend the rules' for his burn patients because of the difficult specialty and vascular access problems.
Just hoping to hear other facilities current practices and policies. I am not finding very much literature. I am hoping to arrive at this meeting with some supporting literature in hand.
Thanks,
KR
In my opinion, the area you described on that patient's upper extremity is definitly not an acceptable site for insertion of a PICC. Bending the rules will only end up with a high infection rate, and treatment costs for CRBSI is no longer being reimbursed by Medicare and many insurance companies have adapted this policy.
I don't understand what you mean by an IJ CVAD that is "at the max number of exchanges." There is no set of guidelines, recommendations or standards that call for neither automatic exchange of any CVAD at a specific time, nor is there any documents that set a limit on the max number of exchanges. This is your own internal policy and this can be changed. But it requires going through the appropriate internal committees.
I would say the attending can "get glad just as easily as he/she got mad", to quote my mother when we were kids. If there had been a PICC inserted in this site and a CRBSI happened and the patient died from the infection , and the family brought a lawsuit - you would have been named in that lawsuit and probably NOT that attending physician. I say this not to add a scare tactic but to encourage you to continue to be a patient safety advocate. In the majority of such cases, physicians are not named and the lawsuit is brought only against the hospital and nurses. 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
What about an tunneled or direct IJ PICC on the other (left) side?
Wendy Erickson RN
Eau Claire WI
The physician stated that the pt did not need another central line....just a PICC..(And yes, I cringe as I type that). Many physicians feel that if it isn't a central line that they place...it really isn't a true central line!!! I did suggest that..
Thanks,Kim