Good morning everyone, Our Vasc Access Service has seen an increase in the number of requests to place a PICC line in patients who already have an indwelling port. The cases vary but the consistent rationale heard from the ordering services is "we don't want to use the port for fear of getting it infected". Is there data/evidence/literature to support this position ?
Here is my rationale to counter those requests.
The patient has demonstrated in some fashion that they need a port for definitive vascular access. Chemo, Iron supplements, exhausted peripheral access...etc., thus a port is placed. The patient is now free to move about the country with their Port.
Pt gets sick & comes to hospital. "DON't use the port, because we don't want it to get infected, place a PICC".
1) We now have TWO lines susceptible to infection. (Even though the port may not be accessed, it is still "at risk")
2) If bacteremia does manifest, wouldn't both lines be at risk for removal ?
3) If the rationale for port insertion is "definitive access" and we are NOT going to use it, why bother in the first place ?
Can someone direct me to evidence ?
David Bruce RN
I totally agree with your rationale. You are right! It makes no sense to put in another VAD for fear that the first will be infected. Implanted ports have the lowest rate of BSI of all types of VADs. So there concern is unfounded, in my opinion.
The issue is more one of drug incompatiblity if multiple infusions must be given together. 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 am glad that we aren't the only ones hearing this. We make the same argument that you do. We agree that it makes no sense to put both at risk. We really try to have them focus on compatibility of drugs and minimize the additional line.
I wish I could quote evidence, but anecdotally, more lines, more lumens increase risk. I am sure that you could site cases that you have encountered that support that rationale. I can.
Gwen
I am glad that we aren't the only ones hearing this. We make the same argument that you do. We agree that it makes no sense to put both at risk. We really try to have them focus on compatibility of drugs and minimize the additional line.
I wish I could quote evidence, but anecdotally, more lines, more lumens increase risk. I am sure that you could site cases that you have encountered that support that rationale. I can.
Gwen