I know the CDC does not reccomend doing an over the wire exchange on a picc line that is suspected of being infected. However, if you have a patient that comes in with a bacteremia and has pos+ blood cultures would it be feasible to place a picc line in this patient, start them on ABX and do an over-the-wire exchange after 48hrs ? What do other hospitals do?
I must be missing something in your message. What is the clinical indication for the exchange at 48 hr? If you are asking about a prophylactic exchange, I would say definitely not. There is no evidence that this would reduce risk for crbsi and it could easily increase risk of crbsi. 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
Sorry about the vagueness of my question, at our facility if someone is admitted with a sepsis from another hospital and has a existing CVL. That CVL must be removed and the pt should be started on ABX for at least 48 hrs before a picc line can be placed. If the pt is admitted with a sepsis with no access they have to have blood cultures drawn and be on ABX for 48hrs and have an improving clinical picture before we can place a picc line. If they need central access the provider has to place a temp CVL and when the clinical picture is starting to improve then we can place a picc line.
Now the problem in our facility is some providers have an increased difficulty in getting someone to place a CVL and they call us (picc team) to place a picc line. To satisfy both the provider and our infectious disease doctors would it be feasible to place a picc line and in 48hrs do an exchange as a prophylatic, the logic would be that 48 hrs does not give the bacteria a chance to colonize the catheter.
I wonder if the question is relating to the concern that placing a PICC line in a patient with an activity bacteremia will increase the risk of developing a septic line? The patient certainly needs the central access; why not just place an antimicrobial PICC?
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA