Forum topic

We have just been talking about this subject at our institution. My feelings on this are that it is impossible to determine if an infection comes from insertion. Once you insert the PICC using the standard insertion practices (max barrier,gloves,mask, chlorahexideine scrub..) and the procedure goes according to plan...how would you transmit an organism into the bloodstream?...Remember, Once your finished , the PICC is then used multiple times by multiple nurses. That means muliple techniques on hub scrub, dressing changes, touching caps,..etc. So you can see to drill down to "what was the specific cause" really is almost impossible. However, in my experience, the known (a VAT insertion practices) vs. the unknown (many nurses access the line and their individual techniques.) I would give the cause to the unknown everytime. If you read the studies and literature regading blood strean infections and what hospitals have done to improve outcomes, it almost always shows when steps are taken to better maintain these lines, the rate of infection drops.......that pretty much says it.

Jack Diemer RN BSN VA-BC

 There is no definitive time line established for CRBSI at XX days always would mean it was caused by insertion vs XX days caused by care and maintenance. However, you can look at the biofilm literature on CRBSI and find that in the first 7 to 10 days of catheter life, there is more biofilm on the outer catheter wall. On the internal catheter wall, there is more biofilm after that period. We can infer that the outer wall biofilm is derived from bacteria that attached on insertion and from the skin due to inadequate catheter stabilization causing catheter movement, inadequate dressings, etc. After that, the risk shifts to what is and is not being done with the catheter hub such as proper disinfection of the needleless connector, improper IV set management, frequent manipulation of the system, etc. This infornation is found in the studies on biofilm and CRBSI. Lynn

Lynn,

I don't agree with that theory. I know you must have studies or some literature that states in the first 7-10 days if a PICC infection is noted, then it must be due to the insertion because of catheter munipulation during the insertion. This has long been a point of contention with me so if you have something, please tell me where I can go to read this.

Thanks

Jack

i AGREE WITH jACK ONTHIS ONE.



I read the study and evidence that you cited Lynn. I still think it doesn't put the blame for extraluminal biofilm on the insertion specifically. It states that in the early days that CRBS'sI are caused by site contamination. But I contest, that still doesn't say it's due to poor insertion techniques. Especially since alot of us still use 24 hr gauze dressings so the catherter is changed by the floor nurse. It also doesn't state the result differences from a non Biopatch dressing vs a Biopatch dressing. I did read the conclusion and he did mention that diligence on the insertion could have a positive impact. But, it would be a stretch to state that definitively an infection within a certain time period is caused by shoddy insertion techniques. he also failed to differentiate PICC insertions from CVC's.

I do believe, based on practical experience, that it seems easy to lump PICC teams in with bad results. But we must not forget, PICC teams are dedicated nurses that just insert lines. A huge differnce from many resident and interns attempting CVC placement. And then next month having a whole new set of those folks.

Jack Diemer

 Jack, I think you have totally misunderstood my origiknal reply to this thread. I never stated that insertion technique was the cause of infection within the first week. That has not been proven What I am saying is that in those first days, there is more biofilm on the extraluminal catheter wall. This leads to the inference that the skin of the patient and/or caregiver is the source of the organisms producing this bioflim. Lynn