Curious what most practices are when placing a PICC with blood cultures pending? For example patient needs a PICC, horrible access issues but has blood cultures ordered. Do you wait till blood cultures are negative for 48 hours or do you place PICC? Do you look up pending blood cultures before placing PICC? Do you monitor labs like GFR for blood cultures prior to placing PICC? Thanks for any feedback.
I am guessing there are no blood cultures already on hand and this would be the first PICC the patient recieves on the current stay. Usually the MDs at our hospital choose to wait 72 hours before even ordering a PICC. Some know the patient will be needing long term antibiotics IV and order a PICC the same day as the blood cultures.
Hope this helps.
Joy Selchow RN, BSN
Nurse Manager
IV Therapy Department
Do you place it then? That's where we run into the issues...
Ideally patient's don't have positive blood cultures, but I'm not sure how placing PICCs or central lines in patients with positive blood cultures can be avoided since potentially positive blood cultures are a common reason why PICCs are placed (sepsis treatment is guided in large part by CVP and patients often require vasopressors).
In our practice we do look at positive blood cultures, creatinine and GFR and use it as a prompt to have a discussion about options. There are rarely hard and fast decisions but rather risk vs benefit. So for positive blood cultures we might opt to place a TLC temporarily or a PIV. Particularly if the pt will have the picc in for a long time, then we will attempt to wait 48-72 hrs before placing a line that will be in longer term. No hard and fast rule her tho.....if we can't get access or this is the best option at the time, then we will place a picc. If pts. creatinine is greater than 2.5,we contact the renal consult if there is one, for clearance. If there is no renal consult, we get clearance from the attending. Since we have not converted to entire electronic charting, it can be difficult to extract information related to plans for fistula placement or preservation of limb for the future. There needs to be a better way to identify these pts. In terms of GFR, we use this as a prompt to ask the question about a renal consult. Hope this helps. Recently our hospital made this all part of a "Picc protocol order sheet". This has helped us in addressing these important questions.
Our vascular access team changes all the picc dressings throughout the hospital and with the excep
Are you able to post the "PICC Protocol Order Sheet" in IV-Therapy.net Forms tab?
We always like to see what others are doing to improve practice
Thank You-Robbin George RN VA-BC
Robbin George RN VA-BC