picc line protocol

iluvivt, BSN, RN · Jun 9, 2008

I am sorry to hear that my prayers to you. Although we can not dispense medical advice I can give some general information that may help you.

1. PICC lines are a very popular form of venous access in part due to their extremely low infection rate. Studies vary but overall only 1-2% of patients with a PICC will experience an infection.

2. Dressing changes are generally done either every 48hrs (if gauze under the dressing) or every 7 days and often will have a biopatch placed at the insertion site to further decrease thei nfection risk. This biopatch has chlorhexadine that will last 7 days. Generally patients in the hospital will have at least a daily flush but often more if they are using the catheter in an acute care setting. Some catheters that are capped off and not used can be flushed weekly.

3. Most catheter-related bloodstream infections come from the patients own skin. This is why it is crucial to use maximum barrier precautions and strict sterile technique when inserting these lines.

4. Patients that get fungal infections are often severely immunocompromised( immune system not functioning properly and pt cannot fight infection as well). Infection can come from another part of the body and infect the catheter.

5.Usually when a patient gets an infection from a venous access device within the first 10 days or so after insertion it is usually related to the actual insertion and after that is usually related to poor care or patient so immunocomprimised they they cannot fight infection .

6. You did not say why your dad was hospitalized that would give us a big clue as to what might have happened Of course you will be told to talk with your dads MD to find out the sequence of events

hope this helps a bit and god bless

IVRUS, BSN, RN · Jun 9, 2008

I was hoping you might be able to send me to links that might help me understand what happened to my father. My father was given a picc line, it was never cleaned after 8 days it was discovered that he had a fungi infection as well as a yeast infection both coming from the picc line, it tested positive. Some of my many questions are; who is responsible for the picc line protocol, after 24 shifts and many different people looking at my fathers chart shouldn't someone have seen that\the picc line was not cleaned? My father died due to the fungi filling up his lungs and he suffocated. I just want to see were the ball was dropped it was the hardest thing I ever had to deal with telling him to stop fighting and go be with my mother. I am sorry for writing to you but if you could help me or know of anyone who could I would truly be grateful!
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I am so sorry to hear about your loved one, however, just because an extra day went by without the needed dressing change, doesn't mean that an infection would automatically ensue.

The fact that the PICC line grew yeast is of particular importance in Hematogeneous Seeding. You see, when this occurs, organisms from a wound or from a source other than the IV catheter will "seed" or collect on the IV catheter. What In essence this means is that the PICC line may not have been the cause of the yeast infection, but rather your loved one had an infection elsewhere which traveled through his bloodstream and collected on the IV catheter. This is what Hematogeneous seeding is, and each and every IV catheter will probably suffer the same fate unless that distant infection is cleared up.

Hope this helps.

Diane

dpcsaw · Jun 9, 2008

thank you for your replies. My father had some internal bleeding and was sent to this hospital to find it. He was in there for 4 weeks, he was walking the halls and doing everything anyone told him, he had 4 Colonoscopy 1 lasting over 3 hours. After the picc line went in, never cleaned within the 1st 24 hours was flushed each time I saw them use it, everything went down hill fast. He was not able to walk the halls and cdc was pumping him with all they could give him. When they did take out the picc line and test it it was contaminated. I have talk with his internist at home, not the hospital were this happened because he had 4 internist and 4 different areas of the hospital working on him during this period of time. So I guess I am looking to see from what I have read on the internet and from his internist the picc line should have been cleaned within the first 24 hours, others have said every three days. So what is the protocol?

IVRUS, BSN, RN · Jun 9, 2008

thank you for your replies. My father had some internal bleeding and was sent to this hospital to find it. He was in there for 4 weeks, he was walking the halls and doing everything anyone told him, he had 4 Colonoscopy 1 lasting over 3 hours. After the picc line went in, never cleaned within the 1st 24 hours was flushed each time I saw them use it, everything went down hill fast. He was not able to walk the halls and cdc was pumping him with all they could give him. When they did take out the picc line and test it it was contaminated. I have talk with his internist at home, not the hospital were this happened because he had 4 internist and 4 different areas of the hospital working on him during this period of time. So I guess I am looking to see from what I have read on the internet and from his internist the picc line should have been cleaned within the first 24 hours, others have said every three days. So what is the protocol?

Each facility has there own protocol, however, using traditional insertion techniques for PICC placement the dressing "normally" is changed after the first 24 hours post placement and then every 7 days and PRN. The reason why it is done 24 hrs post placement is because when the traditional method is used, the introducer used in its placement is large and there usually is bleeding the first 24 hours. If, however, the PICC was placed using the MST procedure, the needle to gain access to the vein is approx. 2-3 sizes smaller than the traditional method and due to less bleeding, the dressing and the policy may not delineate a 24 hour dressing change. INS (which stands for Infusion Nursing Society and is the benchmark for IV therapy practices) has every 7 days and prn for its dressing changes on a Peripherally Inserted Central Catheters.

Hope it helps.

DD