Central Line Question

[calistami]

Hey! I have a question for experienced nurses and central line experts.

A patient (a very active sleeper) somehow got their PICC line cap and T-connector unhooked from the PICC itself while asleep so that the PICC itself was open to air, and the patient also bled from the line, of course; when discovered, the line/site was cleaned vigorously & a new set-up was applied, the PICC still gave great blood return and flushed fine. It's unknown how long this was unhooked, although the max would be a little less than 2 hours (the last time the patient was checked before this was discovered.) Very scary. Physician was notified, new orders etc.

I guess I have two questions: How long does it sound like this line was open for, considering that it flushed without any problem, and was not hep-locked at the time of the incident (had IVF running which obviously became unhooked when the set-up came unhooked), or does that not have any bearing on the issue? It also didn't SEEM like there was a lot of IVF that had run into the floor, but that is very hard to gauge I guess. Also, if the patient were going to get some kind of infection from this situation, how long before they'd likely start showing symptoms?

[FlyingScot, RN]

The line needs to be pulled and replaced.

Actually, let me clarify. The line should have been immediately capped off, not flushed , not reconnected and then it should have been pulled. There is no way to know what kind of debris got into the open end and there is no way to clean the interior of the hub. It's pretty much too late now.

[Sugarcoma, RN]

Agree with FlyingScot. The line should have been pulled and replaced immediately due to infection risk. This is the policy in my workplace.

[calistami]

Thanks guys. Makes sense now, but none of us working that shift had had this happen before and I guess in the heat of the moment, the nurse who found the situation just kind of did what came naturally. We did call the doctor immediately and get their ideas on what to do. I appreciate the feedback.

[LouisVRN, RN]

Personally my first concern would be of an air embolism, I know this risk is rare, but would be my first reason for not flushing the catheter.

[dbscandy]

:eek:AAAGH!! No cleaning, no flushing, cap and call the MD!!!

Actually, you couldn't pull the line without an order, and if the MD let it stay in, it's on him/her.

Did the patient at least get antibiotics to cover this situation???????

[JemJ]

BTW, though, doesn't an MD have to pull the PICC line? We can't do that at my hospital, although we can pull regular CVCs.

[dbscandy]

In my NICU, only PICC team members or the NP can remove them. Oh, and the MD but most likely one of the others.