PICC line in IVDA pt

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Specializes in Endoscopy.

Quick question...

I see PICC lines on a regular, daily basis. I work in a county hospital and deal with a lot of pt's with drug abuse issues as well, some even homeless.

I have seen a couple pt's with active hx of IVDA have PICC lines placed for antibiotic treatment d/t infection. Recently, we had two diff IVDA'ers discharged with their PICC lines on home health for abx infusions. One of these pt's was homeless upon admission and d/c'd to a group home.

I asked the other nurses on my unit about sending pt's with known history of IVDA home with PICC lines, many of them said they do not usually see this happen. I questioned the doctors who stated they send pt's home with PICC lines all the time (which i know...but was more concerned about the drug issue and possibility of jepordizing the healing process or causing a worse infection )

I was just wondering if any of you have seen an incident like this/ or if this is common in your facility?

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Specializes in ER, ICU, Infusion, peds, informatics.

it is becoming more common.

usually, we try to d/c ivdas that need long term abx to a snf for care and monitoring.

however, these patients also tend not to have health insurance, so finding a snf can be difficult. it was usually dependent on the snf having any charity beds available.

the home iv therapy pharmacy i worked for would sometimes take on these patients. generally, we did it only as a last-resort option, and tried to leave very little supplies (eg, no "extra" syringes) in the home. and, of course, careful monitoring of the picc for any s/s infection.

honestly, though, whether they are at home or in a facility, they will find a way to shoot up through the picc if that is what they want to do. i've had plenty of patients that "just have to go out and smoke" as soon as i placed the picc, not even waiting for the cxr to be shot (with noticeable mood/behavior changes afterwards). we have to chase them down to get the xray done. others have friends/family bring them their drug of choice and shoot up in the bathroom as soon as i'm out of the room.

sure, being at home makes it easier, but as the saying goes, where there is the will, there is a way.

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Specializes in neuro, ICU/CCU, tropical medicine.

PARTY!!!!

When I worked the floor I lost count of the number of IVDA patients with central lines I saw 'go out for a smoke' and come back stoned and with crud visible in the line. What are you going to do? You can't restrain them for that. I had one doc write an order to keep a patient from leaving the unit - sorry buddy, I'm not a cop and I long ago gave up letting myself get the crap kicked out of me by belligerent patients. They don't pay me enough and I'm trying to make it out of this gig without ending up disabled.

So what are you going to do?

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Specializes in Endoscopy.

yeah, i have also had a couple of MDs write orders such as "pt does not have hospital privelages". They do find a way to "sneak out" though.

We one time had a pt who had a morphine PCA pump....would often go off the floor to smoke...until someone reported him. He was disconnecting his IV tubing and attaching it to one of the other patient's who was downstairs as well...he would let the other pt use the PCA button. This apparently went on for a while, until someone finally reported him.

I guess nothing should suprise me anymore.

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Specializes in neuro, ICU/CCU, tropical medicine.
He was disconnecting his IV tubing and attaching it to one of the other patient's who was downstairs as well...he would let the other pt use the PCA button.

Was the other guy paying him for the privilege?

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Specializes in Cardiac Telemetry, ED.

I've heard of the physician making a contract with the patient that they would be randomly drug tested, and if even one test came up positive, the PICC would be removed.

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Specializes in Endoscopy.
Was the other guy paying him for the privilege?

from what ive been told, the other guy was giving him cigarettes in return for the meds...:smokin:

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Specializes in ER; HBOT- lots others.

ppl wil do anything, and are the most creative sons of guns out there!!

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PARTY!!!!

When I worked the floor I lost count of the number of IVDA patients with central lines I saw 'go out for a smoke' and come back stoned and with crud visible in the line. What are you going to do? You can't restrain them for that. I had one doc write an order to keep a patient from leaving the unit - sorry buddy, I'm not a cop and I long ago gave up letting myself get the crap kicked out of me by belligerent patients. They don't pay me enough and I'm trying to make it out of this gig without ending up disabled.

So what are you going to do?

AMEN brother!!!!!!!!!!!!!!! I had one patient who shot up through her triple lumen, promptly arrest, we CPRed her until we got the narcan in and she woke up ready to kick our A++. Signed out AMA next day!!!!!!!!!!!! Go fig!

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Specializes in Neuro/Trauma SICU.

I guess the way that I look at it is... you aren't going to solve their problem by not sending them home with a PICC line, and you most likely won't be able to find access when they need the abx if they didn't have the PICC. If they are not serious about giving up the drugs they will get high with a PICC, or without one.

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Specializes in neuro, ICU/CCU, tropical medicine.
ppl wil do anything, and are the most creative sons of guns out there!!

No kidding. Back when I worked rehab we had a guy who cut his way out of leather restraints using the orange juice can that came with his breakfast.

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I questioned the doctors who stated they send pt's home with PICC lines all the time (which i know...but was more concerned about the drug issue and possibility of jepordizing the healing process or causing a worse infection )

The fact that they get high unfortunately doesn't do away with our responsibility to treat their active medical issues.

Basically you get three options:

1) Refuse to discharge them until their infection is cleared. In my world that means a 6-12 weeks hospitalization. Odds are they don't have insurance, and will never pay that bill.

2) Refuse to treat them with IV antibiotics and send them out on oral antibiotics. This is a violation of the standard of care for many serious infections, and opens us to malpractice suits.

3) Counsel them on using the PICC to get high, document it, and send them out ackowledging that at the end of the day, people are adults and make their own choices.

It's easy to say that addicts shouldn't get PICC lines, but it's a little harder to figure out what to do instead.

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