PICC lines and ?Infecton

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Specializes in correctional, psych, ICU, CCU, ER.

OK, nurses..I need opinions, facts, experiences

How long, would any of you say, it takes for an infection to start in a PICC line???

I recently had a newly arrived inmate with a PICC line, he had no idea how long it had been in place, or how long it was.

He said he has 'chemo', (but didn't know the name of his medication) every 3 weeks, last infusion was 3 days ago..he's not sure how often the line is maintained or when the dressing was changed last.

The inmates are usually less than reliable historians..so, it's tough to believe anything they tell us.

There's no way to verify any of this...my hands are tied....I have many concerns about this IM and his line.

Alll of that aside, how long, would any of you say, it would take before I'd 'worry' about an infection..I figure, IF he had chemo 3 days ago, his WBC would be dropping, and even though our facility is cleaner than most of their outside living quarters, I'm still VERY concerned about infection..(among other things,) considering MRSA runs rampant both in jails and our community......

Also, IM's have been known to harm themselves, in an effort to get out..he may pull out the line and where he is, it could be 15 minutes before he's discovered....I can't keep him in sight until I can have him transfered...another concern..

I used to put PICC lines in, but that was 1994-2000, so I'm sure things have changed since then...

I was told 12-14 hrs here was 'no big deal...if it was 24 hrs, THEN I should start to worry'...I disagree...

Any experiences?? Thanks in advance...

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Specializes in LTC,Hospice/palliative care,acute care.
OK, nurses..I need opinions, facts, experiences

How long, would any of you say, it takes for an infection to start in a PICC line???

Ihe's not sure how often the line is maintained or when the dressing was changed last.

Alll of that aside, how long, would any of you say, it would take before I'd 'worry' about an infection..I figure, IF he had chemo 3 days ago, his WBC would be dropping, and even though our facility is cleaner than most of their outside living quarters, I'm still VERY concerned about infection..(among other things,) considering MRSA runs rampant both in jails and our community......

QUOTE]

I'm in LTC and our policy regarding PICC lines is daily flushing (when not in use) ,dressing change q 5 days and visualization of the site every shift .In my experience they can become infected at anytime-(via loose dressings/during dressing change) -I would think that checking the site q 4or q 8 hours would be satisfactory-and report any sign of infection to the doc.Do you change dressings of every kind when your inmates arrive and assess whatever is under there? I think it would be very important in that population to document if they have s/s of infection upon arrival. Is it possible to contact whomever inserted it? You've got to find out how long it is-suppose he does pull it out? Your facility really needs a policy...

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Specializes in correctional, psych, ICU, CCU, ER.

Thanks--

I do examine wounds, etc. when an IM arrives..I can't remember a time that we have ever had a PICC line here..occ. we get a heparin lock that wasn't removed at the local ER..we remove it and dress the site...we have nothing to flush or maintain the line here...we sent IM's out who are more complicated medically than we can handle...no way to get history, they usually are pts of the VA, county hospitals, or prisons and it's next to impossible to pin down records....I'm just curious if anyone has experiences or opinions on how long it 'takes before I worry about infection beginning'...maybe I'm just being a worry wart. I'm just trying to protect my license and give good IM care. sigh

PS LOVE your quote!!! Sounds like someone I know!!!

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Specializes in LTC,Hospice/palliative care,acute care.

I bet you'll be seeing more and more of this type of thing-Your powers that be are going to have to get you all prepared. No supplies? I don't know how long you can let a PICC go without flushing before it's in danger of clotting up-maybe someone else knows that.For you I think checking the site every shift would be reasonable-you want to be able to catch a problem quickly and take any action needed.You could see an infection develop at any time-I've had them develop the day after insertion and I've seen patients maintain a line for months with no problem.Do you think he would harm himself and pull it? Do you have a policy for that? Maybe suicide precautions? It takes a special kind of nurse to deal with that population-it isn't my cuppa tea,for sure...

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Specializes in correctional, psych, ICU, CCU, ER.

I couldn't jusify putting him on suicide precautions for possibly pulling out the line--plus, where he was housed is where they would have put him for SP anyway, and they are checked q 15 minutes.

I was having him transfered out on my shift, but he'd been there since 1930 the night before....

Tell me about 'policies'--what is it they say about a committee???? sigh

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Specializes in Home IV infusion.

dear jailrn,

regarding how long you can go between flushes, it depends on the type of picc. certain types can go several days without flushing. really, really basic cleaning of the site and the extension per the most picky aseptic protocol you can find (i use the web for this), may prevent an infection that would like to start up. a ltc facility i recently worked at that had a high population of "former" drug abusers, worried more about shooting up into the picc than about the patient pulling it out. depending on your inmate's mental and emotional stability, i would think he should be under some kind of visual frequently, like q 15 min, in addition to the infection-prevention q shift. if it's true that you're going to be seeing lots more like this-- good luck with creating policy and protocol-- a terrific challenge

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