Femoral CVLs- do you change the site? - page 2
by Ashley, PICU RN 3,116 Views | 12 Comments
I recently learned that, in the adult ICU in our hospital, if the patient has a CVL placed in the femoral site, it has to be changed within 24 hours. This is due to the increased rate of infection of the femoral site. Our PICU... Read More
- 1Jul 1, '12 by iluvivtThere is no recommendation in the 2011 guidelines form the CDC stating that femeral lines must be removed in 24 hours..not even in adults. What they do say is to avoid using the femeral veins with your first choice being the Subclavian (avoid this approach with HD pts). In adults this is b/c of the higher infection rate in this site due to a variety of reasons. In some studies as high as 19 percent BUT in children the association between use of a femoral line and CA-BSI is not as clear as it is the adult population. When deciding what is the best CVC for any given patient ..you need to ALWAYS weigh the risk to the patient vs the benefit. So for example, if a proceduralist thinks the risk is too high (for whatever reason) for a pneumothorax or other complication b/c of a difficult access by all means they can and should try a femeral line. I often find that if a femeral line is placed..other sites such as SC and jugular have been attempted or were not attempted b/c of urgent need for the CVC. The femeral vein is easy to hit doing a blind stick
- 1Jul 2, '12 by NicuGalOur IR places PICC's in the femoral for us. We rarely use broviacs anymore. We do use biopatches on our kids, we have only had 2 in the past 3 years that had a reaction to the patch, but we think it was more that the fellow didn't wipe off all the chlorohex before placing the dressing, and it left a nasty burn We leave lines for as long as we can. Even our adult floors don't change PIV's and central lines the way they used to. If it ain't broke, leave it be!
- 0Jul 2, '12 by umcRNGod if we had to change the PIV's q96 out IV team would march out! Haha on my unit it's unfortunate that most nurses do not know how to place IV's. Coming from the NICU I do know how to and will generally stick most my kids but some of the chronic cardiac kiddos have NOTHING and I get afraid to even call IV team because I know they're going to take their anger out on me. Ugh.