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Found cap off port of PICC

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by scoochy scoochy (Member)

scoochy has 32 years experience and specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.

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iluvivt has 32 years experience as a BSN, RN and specializes in Infusion Nursing, Home Health Infusion.

2,716 Posts; 24,348 Profile Views

Yes we follow all current standards of care....YES we use max barrier precautions during insertion...we use CHG and let it air dry..we all wear masks gowns gloves and cover our hair........we faithfully change our dressing and caps on time...we do most of the dressing...on occasion a nurse may have to do one.....we educate on 15 sec cap and hub scrubs and tubing changes and the difference between sterile and clean..we educate on the s/sx of complications..we do it all and provide excellent care....... If you think a line should always be replaced after a cap falls off (again weighing all the factors involved) how can you explain repairing a PICC that is broken and snapped off. or any CVC for that matter..We recently had a tunneled Lenord catheter that broke......so I had to overnight the repair kit.....so I clamped the cather off..and scubbed the entire broken section and folded it over and wrapped in some sterile 4 x 4 s. I had some Tpa ready the next day in case it was occluded...I repaired it and it still had a great blood return!!!

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This incident occured at our facility as well. The "experts" removed the PICC, placed another and patient had blood cultures drawn as well. Perfect situation for all those germs to get right in there.

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Rexie68 has 21 years experience and specializes in Vascular Access Nurse.

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....... If you think a line should always be replaced after a cap falls off (again weighing all the factors involved) how can you explain repairing a PICC that is broken and snapped off. or any CVC for that matter..quote]

We just don't. We do not repair any of our CVCs. In fact, the company that makes our PICCs does not even make a repair kit. We will pull it and put in a new PICC, unless there's an extreme situation that makes it dangerous to do so. Perhaps we're doing overkill, but our CRBSI rate is extremely low...less than 0.05%. 0% would be better, and we're hoping to get there!

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Rexie68 has 21 years experience and specializes in Vascular Access Nurse.

296 Posts; 3,507 Profile Views

This incident occured at our facility as well. The "experts" removed the PICC, placed another and patient had blood cultures drawn as well. Perfect situation for all those germs to get right in there.

I would have done the exact same thing. Much less likely that "germs" will infect a new PICC placed under max-barrier precautions than a PICC found with the cap off. We would also do the same thing if a PICC were found with the dressing off. Again, perhaps some think it's overkill, but it works for us. We're very, very protective of any of our central lines and have an infection rate to prove it works.

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iluvivt has 32 years experience as a BSN, RN and specializes in Infusion Nursing, Home Health Infusion.

2,716 Posts; 24,348 Profile Views

OK..this is NOT an unaccepatble practice to replace a cap if it has been found OFF. The immediate concern would be for air embolus I also did check with the national experts. Think about this as well.... many imtermediate type and long term lines ARE repairable..there has been a "break" in the system.....we cleanse it and repair it and use it...we DO NOT take it out b/c of the compromise. Now with this situation what one needs to understand is the basic causes of catheter related BSI (blood stream infection). ...it comes from the skin AND can also gain entry through the catheter lumen..about 80 percent of the bacteria can be removed with the prep on insertion..the rest of the bacteria adhere to the catheter as it passes through the skin during the insertion. Those bacteria create biofilm ( a slimy substance) . During week one of dwell time there is more biofilm on the outside of the catheter.....after one week there is more on the intraluminal sufaces (the inside of the catheter) , So after one week there is already a significant amt on the inside of the catheter and thus the risk for infection is not increased. so its not really quite as simple as take it out an put another in

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Rexie68 has 21 years experience and specializes in Vascular Access Nurse.

296 Posts; 3,507 Profile Views

Well, we can agree to disagree. My facility does not repair any central lines....not picc, dialysis, presep, multi-lumen, etc etc etc. It works for us. We're very lucky to have a "specials" unit that has a physician who works under flouroscopy to place/replace any line that IV team or the docs on the units can't get with ultrasound guidance. Our central line infection rate is less than .05% so we must be doing something right! :twocents:

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