Hi I am interested in where I can find data on when it if accceptable to change PICC's over a wire. Also looking for a P and P for our institiution. Thanks
The only articles available when we wrote the 2011 INS Standards of Practice are listed in that document. I did not find much but what I found is in there. This lit search was done in late 2009/early 2010. So you could search from those dates to add to what is in the SOP document. I have not found a list of conditions when it is acceptable to exchange any CVAD. Lynn
the most common reason for catheter exchange for us is when a patient with a picc has a worsening of condition that requires additional access with central meds, pressors/antiarrythmics/ vessicants or multiantibiotics. Second would be catheter malfuction. Infrequent but possible that 1 lumen of multilumen cath has an occlusion that cannot be cleared with tPA. Also infrequent but possible is catheter malposition. Either tip migration or suboptimal placement. Lastly that I can think of is a matter of debate, one that we are currently having and is mentioned in another post, is initiation of TPN with a picc that has previously used for other infusions. There is debate regarding dedicated lines and "Virgin/Sterile" line to start TPN.
In all, I find exchanges to be rather infrequent, but certainly preferable to a new start when there is no issue with infection, contamination, or compromised insertion sites.
The only other thing i would mention is exchanging a PICC without a wire using just the break-away introducer. We have had instances of intralumenal contamination, caps left off, broken hubs ect. on single lumen piccs. If everything under the dressing is intact and clean and benign, we have exchanged the picc using the introducer with the inner micro-portion removed. Setup for the exchange is the same, except that after the old picc is withdrawn and cut, instead of advancing a wire into the picc lumen, you would slide the introducer up the picc, into the vein, and remove the old cath. This avoids putting a wire through the contaminated lumen.
Mickey Hawes answered this question at AVA last week in her presentation on midlines. She said she has done this exchange in the past but it is a case by case decision. What went through the midline? For how long was it used? What is the site condition now? All this goes into the decision about exchanging for a PICC. Lynn
New insertion is always preferable to wire exchange, wire exchange is always preferable to through the introducer exchange in my opinion. The amount of contamination simply has to be greater with the old PICC touching the inner surface of the introducer and then the new PICC running through the same introducer. From a microbiology standpoint I would much prefer the wire going through a contaminated lumen, as the dilator portion of the introducer is removed after wire removal and the new PICC can pass through something that the wire has had no contact with. Through the introducer method guarantees surface contact between old PICC and introducer and new PICC and same introducer!
The only articles available when we wrote the 2011 INS Standards of Practice are listed in that document. I did not find much but what I found is in there. This lit search was done in late 2009/early 2010. So you could search from those dates to add to what is in the SOP document. I have not found a list of conditions when it is acceptable to exchange any CVAD. 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
the most common reason for catheter exchange for us is when a patient with a picc has a worsening of condition that requires additional access with central meds, pressors/antiarrythmics/ vessicants or multiantibiotics. Second would be catheter malfuction. Infrequent but possible that 1 lumen of multilumen cath has an occlusion that cannot be cleared with tPA. Also infrequent but possible is catheter malposition. Either tip migration or suboptimal placement. Lastly that I can think of is a matter of debate, one that we are currently having and is mentioned in another post, is initiation of TPN with a picc that has previously used for other infusions. There is debate regarding dedicated lines and "Virgin/Sterile" line to start TPN.
In all, I find exchanges to be rather infrequent, but certainly preferable to a new start when there is no issue with infection, contamination, or compromised insertion sites.
The only other thing i would mention is exchanging a PICC without a wire using just the break-away introducer. We have had instances of intralumenal contamination, caps left off, broken hubs ect. on single lumen piccs. If everything under the dressing is intact and clean and benign, we have exchanged the picc using the introducer with the inner micro-portion removed. Setup for the exchange is the same, except that after the old picc is withdrawn and cut, instead of advancing a wire into the picc lumen, you would slide the introducer up the picc, into the vein, and remove the old cath. This avoids putting a wire through the contaminated lumen.
Also wondering about exchanging a midline for PICC if therapy needs change.
Assuming midline is placed using full barrier, patient now (for instance) will be placed in short term rehab and requires PICC. Exchange or Reinsert?
Mickey Hawes answered this question at AVA last week in her presentation on midlines. She said she has done this exchange in the past but it is a case by case decision. What went through the midline? For how long was it used? What is the site condition now? All this goes into the decision about exchanging for a PICC. 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
New insertion is always preferable to wire exchange, wire exchange is always preferable to through the introducer exchange in my opinion. The amount of contamination simply has to be greater with the old PICC touching the inner surface of the introducer and then the new PICC running through the same introducer. From a microbiology standpoint I would much prefer the wire going through a contaminated lumen, as the dilator portion of the introducer is removed after wire removal and the new PICC can pass through something that the wire has had no contact with. Through the introducer method guarantees surface contact between old PICC and introducer and new PICC and same introducer!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness