I am still in orientation with regards to placing PICC's. I heard a ICU nurse say a patient was not a canadiate for picc placement because he had a + BLOOD CULTURE for strep. I thought all the more reason for him to have long term antibiotic's and a PICC line. But I am new at this...I need an experienced PICC nurse to shed some light on the right answer. Thanks!
Oct 17, '06
Ideally, you want the patient to be on treatment for the infection and then once the patient is no longer febrile, place the line. In other words, place a short term periph until the above occurs, then place the PICC. What you don't want is the PICC to be seeded, or colonized with the bacteria that the patient has because once this happens, the bacteria can be very difficult to remove. More and more we see what is called hematogeneous seeding. The patient may start showing s/s of sepsis, and the MD may say, "ah, it's that PICC," and order the removal of it. But in reality, it may be a result of bacteria from the distant foci, colonating on the catheter creating a biofilm and slime production which sets off a whole other set of problems.
Oct 21, '06
Positive blood cultures are a relative but not absolute contraindication for a PICC,so you need to look further into the situation and weigh the risks and benefits of both placing and not placing the line. If the only viable option for access is the PICC and the patient won't get the needed treatment without it,place it--the patient is already septic,so you won't make her "more septic" by placing a line,and you'll provide the needed access for the antibiotics. You may,however,expect to have to replace the line after a few days of treatment no matter what the culture results are.
Other scenarios exist,of course. If the patient had + cultures two days ago,has had a few days of antibiotics and is otherwise improving,you should be safe to place the line. Or if they have adequate access now with + cultures,go ahead and wait.
One way or another,this is a matter you might want to discuss with your infectious disease doc's and develop a process for.