Very occasionally we need to catheter exchange a PICC line if the patient has very limited iv access ie fistula, ivda, mastectomy and the catheter breaks or becomes malpositioned due to migrating out. Is there any INS restriction to catheter exchange. I understand the risk of infection. Does anyone have any standards re PICC exchange?
See Standard 56, page S75 Central Vascular Access Device Exchange in the 2011 edition of Infusion Nursing Standards of Practice. 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
I have had many discussions about the appropriateness of catheter exchange when there has been a compromise in the dressing. Given this scenerio could you analyze and make recommendations:
A patient has been working with physical therapy ambulating to the restroom and accidentally pulled the PICC out 12 cm. The nurse was called and catheter taped down so no futher dislodgement would occur. IV Team was called to eval the patient. The patient was going to need 2 more weeks of Vancomycin daily. No redness, swelling or pain at insertion site.
Would exchanging the catheter be consider an option? Describe principles in your decision making.
Matt Gibson RN, CRNI, VA-BC
First - Primary care nurse intervention was appropriate.
Second - some type of CVAD will be required to complete the therapy - vanco for 2 more weeks
Third - the present PICC is not sufficient for this therapy
Fourth - exchange over a wire is intended for this type of situation. Skin can never be rendered sterile. So all external catheter segments will be contaminated in every patient - no exceptions. Compromised dressing should not be the main criteria to do or not do an exchange. External segment must be thoroughly cleaned before the procedure. During th procedure consider this segment to be contaminated and avoid cross contamination with the sterile new catheter by changing gloves, and keeping the old catheter from touching the same portion of the sterile drapes as the new one. This is not easy but it can be done. If patient has sufficient venous access the better option may be to remove this one and insert a new one. You must evaluate the risk vs benefits for this patient.
Fifth - assess your catheter stabilization practices as there seems to be a problem that allowed this dislodgement in the first place.
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
I have had many discussions about the appropriateness of catheter exchange when there has been a compromise in the dressing. Given this scenerio could you analyze and make recommendations:
A patient has been working with physical therapy ambulating to the restroom and accidentally pulled the PICC out 12 cm. The nurse was called and catheter taped down so no futher dislodgement would occur. IV Team was called to eval the patient. The patient was going to need 2 more weeks of Vancomycin daily. No redness, swelling or pain at insertion site.
Would exchanging the catheter be consider an option? Describe principles in your decision making.
Matt Gibson RN, CRNI, VA-BC
If you have a pt that has chronic renal failure and you as a picc nurse have only one arm to utilize. If you have a picc line in place that the physician is wanting replaced due to lack of blood return. Cath-flo has already been used on the line and the line is still not drawing blood. Would you consider and over the wire exchange? Should you try a different site or vessel or what would be the most appropriate choice?
Cindy Clinkenbeared RN, VA-BC