Missing Cap on PICC line

[janeybirdRN]

I work night shift and in the morning, I took a patient to the bathroom that was not assigned to me. She reached under her right arm and said what's poking me? I saw her PICC line and there was no cap on the end of it! Huge infection risk. I'm thinking how long has this been like this? Why is this like this? What is going on here? The nurse taking care of her is an LPN. I let the charge nurse know and apparently the assigned nurse said the patient was messing with it at some point but nothing about the cap missing.

What should have been done in this situation?

Personally, I feel like the doctor should have been called and we should have got an order to remove the line.

[nurse2033, MSN, RN]

Why didn't you call the MD? They should be allowed to measure the risk. Obviously you should aspirate to make sure it is patent and get any air out, flush, then put a clean cap on. If a cap isn't screwed on tight it can come off when a syringe is unscrewed. Or the patient may have been messing with it.

[IVRUS, BSN, RN]

Remove the line??? I wouldn't have done that either. If someone erroneously removed the injection cap while disconnecting the syringe, well that is a problem, especially if the line wasn't clamped at some point. Or, if it is a valved IV catheter, then one should just worry about bacteria entering the line as it was without a cap. Here is what I believe should have been done: Hook on an empty syringe and aspirate approx. 5 cc of blood. Then, Flush with a good 20 cc NSS and place a well fitting Luer-Lock injection cap on it. The complications/trauma to the pt and expense do not warrant a removal and reinsertion in my opinion. Let the MD know your interventions and then monitor the patient well for s/s of local and systemic infections.