PICC reaction vs infection

[JOPICCRN5]

Need some advice. My team has been having a recent problem with PICC infections lately. My question is when the cultures are coming back negative are the floors getting excited and pulling PICCs that are only showing a reaction and not an infection and how do we educate them on the difference. (they rarely listen anyway!) I know sometimes the only way to tell is to pull and culture but that is really distressing for the patient.

How long after a PICC is placed is it an infection from being placed? How long after placed is it infection from how the floor manages it or the fact the patient has a severe infection to begin with? We do not go back and do the dressing changes or cap changes at this time. (we want to but our boss wont let us). We also use only one person to start PICCs not 2 like most teams I have read about. Thanks in advance.

[Kim Valentine, BSN, RN]

I recommend using the Biopatch along with a securment device like Statlock. The new stats on Biopatch state that PICC infections are reduced by 60%. That is a significant evidence for me to adapt my practice.

[piccemrn1]

Actually, if the inserter infected the patient, literature strongly suggests the infection will manifest with 24-48 hours. Any time beyond that, it can be line manipulation, lack of hand hygiene or access technique. If an infection is suspected, check xray for PNA, urine, or wound/source..If picc line is still suspected draw 2 sets; one directly from the line and a peripheral, then culture your tip. It is also recommended to wait 24-48 hrs before placing another line.

[BabyLady, BSN, RN]

Not sure if this applies, but in the NICU, we do PICC lines constantly.

Here is our infection control measures:

1. PICC line placed via sterile procedure using Chlorhexidine Gluconate to prep the site.

2. PICC dressing is only changed in 24 hours if the dressing is dirty...if it's a scant amount of blood.....no change is made unles the dressing is dirty or coming off.

3. No access to PICC's or INT's unless site is cleaned with Chlorhexidine Gluconate for 15 seconds and allowed to dry for 30 seconds..and I'm not kidding you when I say..yes, we do follow that to the letter.

4. Cap changes are done by the RN's under full sterile procedure every 72 hours...that means, mask, gown, sterile gloves, etc.

5. PICC's that are pulled or just pulled out are also done under sterile procedure.

Yes, it is alot but our infection rates and culture rates are virtually zero in our department..we will actually go for months without getting one.