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Greetings! I had a very disturbing recent experience with a physician. I was called by social services re: home care protocols for a non tunneled, non-valved, triple lumen central line. This line had been placed on a 36 year old female in the OR related to reported difficult venous access. This patient had a diagnosis of ovarian cancer and looked to be doing fairly well at the current time. She had orders for discharge and was also scheduled for chemotherapy in about a week from discharge. The patient was under the impression that she had a "PICC line" and wanted it to remain in place for her chemotherapy. The surgeon had written two orders in regards to this line. One was "Do not remove central line prior to discharge" and the other was a social service consult re: "central line home care". I did not feel that sending the patient home with this line was appropriate and was down right unsafe. I opted to call the oncologist (bypassing the surgeon for now) and explore the actual central line need. I did this with the thought of placing a PICC line prior to discharge if need be. I was told that the patient was scheduled for a one time nonvesicant 6 hour infusion. The oncoligist agreed that this line was not needed. I was told that if the patient looked like a peripheral IV site could be obtained that she would not even need a PICC line. I had assessed her and felt that this was very feasible. I am not sure if that is due to skill level or perhaps she was now better hydrated, etc. since her surgery was done. Had the patient of gone home with this line the outpatient entity that would care for it would have been the oncology nurses. They are not available 24/7. The patient did not have an appointment scheduled for almost a week. The line could not be flushed or properly maintained. The patient was at risk for air embolism should the perfect storm take place. The infection risk was too large in my opinion for this immunosuppressed woman to go home with this unneccessary triple lumen central line with the other risks as mentioned above. The oncology office and myself decided that the best scenario for the patient was to not have a line at all. I explained this to the patient. She and her family were fine with the decision. I then spoke with social services. They were nervous because "that isn't what the doctor ordered." They requested that I call the surgeon to make sure it was ok. I understand that the physician ordered this to go home with the patient. As a patient advocate I was not going to allow the order to be carried out. I did go ahead and make a courtesy call to the surgeon. The OR nurse called me back and what took place was basically a situation I was very uncomfortable with. I reported to the surgeon (during another surgery via the OR nurse) the situation, my concerns, my consult with the oncologist and that we would be removing the line. The surgeon was angry and said, "Do not remove that line." (I could here her in the background.) When I spoke with the relaying nurse I told her that I could not follow through on that order. She told that surgeon, who was quite upset, but who then agreed I could "if it is ok with the patient." The surgeon was also upset and said, "I send people home with them all the time." The disturbing thing is that social services would have and the bedside nurse would have as well per her report to me. Neither understood the risks and had I not of been available to consult on the situation she would have gone home with that line. I wrote it up for review so that the MD involved and the IV team, social services and bedside nurses could all be on the same page. My boss said that she needs literature to support the safety (OR NOT) of these lines in the home environment. I absolutely get that at times there is an exception to every rule. However, sending a young patient that is doing fairly well home with an unneccessary infection and air embolism risk with noone to care for it should not ever happen, regardless of patient or surgeon opinion. Am I crazy?