We routinely have orders to place a PICC line in order to remove a quad lumen or IJ. Sometimes we have to use the ipsilateral side and due to medication needs the current line cannot be removed. This kind of placement we always get an xray to confirm that the PICC wasn't dislodged. What are your thought on this from a CLABSI standpoint ??
My second question is if you place a PICC on the contralateral side from the quad lumen do you need to order an Xray to confirm that the PICC wasn't malpositioned when the quad lumen was removed since it only shares the SVC portion of the vasculature?
I don't know of any evidence on CLABSI rates with this situation but have not done a lit search on this question. If there is an infected fibrin sleeve or thrombus, your PICC is being placed very near it. RE xray - I would place the PICC, remove the other CVAD, then get the xray. IMHO, this is better than subjecting the patient to 2 xrays, one to confirm PICC tip and one to confirm no tip migration.
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
Lynn,
In your opinion if the PICC is placed and confirmed to be in SVC/CAJ per ECG on the opposite side from the CVAD would you get an xray to confirm that PICC is not displaced with the removal of the CVAD?
I don't recall any published data on this, but confirmation of PICC tip location after removal of the first CVAD would be a good idea regardless of the side of insertion. Do you have a skilled assistant that could remove the CVAD wihle the PICC insertion field and wire is still in place? You could confirm that PICC was still in correct place but there could be challenges with trying to do this. The other option is to use US to rule out PICC tip migration to IJ, but there are still other places it could go.
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