I have been trying to update our practices at the facility where I work as a Vascular Access RN. I have a couple questions to see what other facilities practices are in relation to ours. If a line has been fractured externally, is it ok to exchange over a guidewire? Or should the line be pulled and a new PICC inserted? When a PICC is occluded and efforts to declot has failed, is it ok to exchange over a wire? If anyone has links or suggestions for websites that I might find EBP on these topics, it would be greatly appreciated. I have been researching and find information for both ways so I would love to hear what others practices are and why that is your practice. Thanks.
The overriding principle is that exchanges should be avoided when possible due to the potential risk for greater complications following the exchange. Infection and thrombosis are the primary ones causing concern and there is not a lot of outcome studies on this. So I would avoid an exchange when possible. This means an individualized patient risk to benefit assessment.
In the first scenario with a fractured external catheter, the exchange vs remove and insert a new PICC would depend upon the the patients available sites for a new PICC, the length of time remaining on therapy, the patient immune status, etc.
When declotting efforts fail, that tells me there is some problem other than intraluminal clot causing the occlusion. This could be intravenous thrombus near the catheter tip, drug precipatate, lipid sludge, or some type of mechanical problem. I would be investigating those issues before I automatically performed an exchange.
You can easily do literature searches on Google Scholar, not regular Google. Also there is PubMed Home - PubMed - NCBI from the National Library of Medicine, although not all journals meet the criteria to be indexed on PubMed.
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