PICC reaction vs infection

That is a hard one. We pull all of our lines, piccs, cvl's, etc. not the nursing staff so we get to assess the line. I would think infection form placement would happen within a few days but infection can be introduced at any point. With cultures being negative, why would they think a line infection???

Wow! I am sure that must be hard. We have had a team since 1973 so there are no issues with boundries for us. 40 piccs per month !! good job

Are you saying that the PICCs are getting discontinued b/c of suspected infection and then the tip culture comes back negative or are you just getting a blood culture. First of all there has been tons of research on all types of CVC-related infections,including PICCs and there are some wonderful recommendations from a variety of sources. I want you to go to the CDC website and download the 2002 guidelines for preventing CVC-related infections. Not only will this educate you it will give you some ammunition for taking over the cap and dressing changes on these line. Research shows that when a dedicated team takes full responsibility for the care of CVCs (dressing changes,cap changes and site checks) the overall infection rate is decreased by 25-30%. That is a huge number. The CDC also has this as one of the highest recommendations!!
PICCS have a very low infection rate. So if yours is high or significant there is room for improvement. Early infection (within the first 10 days) usually can be blamed on insertion techniques. Later infections can usually be blamed on improper care. Are you using Maximal barrier precautions,a 2-step chlorhexadine prep,biopatch at site...etc. Also you should push for another PICC nurse for your assistant. An MD never places a CVC without one,why should you. In addition, the assistant can monitor for breaks in technique. It is also a huge time saving factor for the nurse and the patient.
The next thing to look at is the use and maintenance. dresiing should be changed whenever the integrity is compromised. Any dressing with gauze should be left on for only 48 hours,whereas TSM dressing can be left in place for up to a week. Are you changing all caps at least every week?Are the nurses using them performing a good cap scrub every time they access them?
Now for the cultures. In order for it be classified as a CRBSI the same organism must be cultured from the blood and from the distal segment of the PICC and they must be in sufficient numbers (greater than 15 CFUs colony forming units). You also have to make certain the nurses are culturing the tip correctly as skin contamination is common.
I could go on and on as I have been studying this for the last several years. I hope this is a start. Any more info you can give me and perhaps we could pinpoint the problem. let me know

by the way what are you referring to when you say reaction...do you mean phlebitis?

To JOPICCRNI I will also direct you to to the IHI (Institute for Health Improvement ) site. There you will find the save 100 thousand lives campaign/ A lot of their recommendations are based on the CDC recommendations. Believe me,I know how sloppy some nurses can be with vascular access devices. We leave a little cheat sheet on the Kardex of every patient that we place a PICC in . There are instructions on how to properly care for these lines. We also periodically audit a variety of these issues,including hand hygiene. We report offenders to the management team. The nurses must know you are serious. Also please join iv.therapy .net or peak in (I am Mary Ann on that sight) If you would like I can send you a sample of the cheat sheets I designed for the Kardex. Also.one study be Maki,showed that approx 40% of the infections from CVCs in that study were from the cap. So scrub the hub campaigns are just as important as hand hygiene. Educate the patient as well when you put the line in. If they are reporting to you that the caps are not getting scrubbed,they are telling you the truth. Any other questions just fire away and I can help or direct you to an answer.

JO PICC. the reaction you described is a sterile phlebitis. I hope you are using Ultrasound to place your PICCs as this will virtually eliminate this complication. This is an insertion related complication and usually occurs early in the life of the PICC (ie.first 10 days). If you would like a copy of the cheat sheet...send me a private message with your E-mail and I will send thatto you