Sending drug abusers home with picc lines?

[JOLLIEHOLLY, RN]

Hello to all. Just curious to what people think about the subject I am about to present. Just to start off, arrest records are open to the public, you are not breaking any law looking up past arrests. So lets say you have a pt that needs long term abx tx. Do you think an MSW should be able to look up the patient's name and see if there have been any prior offenses of drug abuse. And if so, opt not to send pt home with a picc line. I myself have heard pt's boast about their meth labs and about previous arrests/jail time, and see them go home with picc's. Of course it happens all the time, however, if research was done, maybe we could prevent this outright abuse. Health care workers pry into almost all aspects of a pt's life to hygiene to religion, so why not multiple drug offenses.

[ohmeowzer RN, RN]

i had this homeless guy who was a drug abuser. he used all the veins in his legs , his legs had huge sore on them.. ugh.. anyway , the pt would try to make his sores worse by scratching them so he could stay in the hospital longer for the dilauded. someone mentioned to him he was going to be discharged to a shelter ( his legs were much better ) and when he got wind of this he snuck out w/ his PICC line. i called the police and they found him and hauled him back to the ED to have that PICC line pulled. he was out for 24 hours with it.. that creep.. i've had people insist on going home w/ a PICC line.. that they paid for it .. it's their property.. wrong .. it gets pulled w/ secruity there.. but we don't check police records on every pt. we are a busy hospital ..

[ohmeowzer RN, RN]

i'm sorry i saw long term abx tx w/possible arrest records.. we still don't don't look up arrest records.. it just dosen't seem right .. the pt is there w/ a conditon that requires a long term antibotic treatment .. they would have a home health nurse in and out of their house or apartments. i think if the home health nurse noticed something untoward going on she would report to the police and the MD and have the line pulled. you just can't deny someone home care because they have an arrest record. they still need the antibotics and they can't stay in the hospital.. wow great topic..

[Elvish, BSN, DNP, RN, NP]

That's a really tough call. On one hand, if someone needs their abx, they need them, like Kizzy says. But it is asking for trouble, IMO.

[CritterLover, BSN, RN]

we tried to send them to ltc for their abx.

it was one of the more common reasons for use of a "charity bed" spot in the snf run by our hospital system (freq these pts don't have insurance).

while i never checked police records, i did use to check msw notes and look for tox screens from old admissions.

if the pt had a hx of drug abuse, and had some dx that lent itself to home iv abx therpy, i talked to the ordering doc before putting the picc in -- just to make sure we were all on the same page.

[JOLLIEHOLLY, RN]

we tried to send them to ltc for their abx.

it was one of the more common reasons for use of a "charity bed" spot in the snf run by our hospital system (freq these pts don't have insurance).

while i never checked police records, i did use to check msw notes and look for tox screens from old admissions.

if the pt had a hx of drug abuse, and had some dx that lent itself to home iv abx therpy, i talked to the ordering doc before putting the picc in -- just to make sure we were all on the same page.

of course they don't have insurance. why the hell spend money to insure yourself when that money could go to getting high? hahahahaha. sure makes a lot of sense, huh? now that is what i call having your priorities straight!:angryfire

[DutchgirlRN, ASN, RN]

I don't know how that could happen around here if the patient doesn't have health insurance. If they do have health insurance I'm not convinced that our doctors would send them home with a picc knowing they are drug abusers. I guess either way I just don't see it happening.

We had one that we caught injecting diarrhea into his picc to acquire an infection that would net him more pain meds. Needless to say the picc was immediately DC'd and a psyche consult ordered.

[leslie :-D]

if they need long term iv abx, then it would be unethical to deny them of that.

true drug addicts are going to get their fix whether they have iv access or not.

and so, no, i have no problems with them being dc'd w/a picc.

leslie

[danamobile]

I don't know how that could happen around here if the patient doesn't have health insurance. If they do have health insurance I'm not convinced that our doctors would send them home with a picc knowing they are drug abusers. I guess either way I just don't see it happening.

We had one that we caught injecting diarrhea into his picc to acquire an infection that would net him more pain meds. Needless to say the picc was immediately DC'd and a psyche consult ordered.

i had a patient like that-- its a psych disorder that causes harm to themselves because of lack of medical attention as a child... munchowsins (bad spelling)..

so coming from canada, things seem to be a bit different here. but many people go home with IV abx? we do have it here, but its not hugely common. most people leave the hospital on oral abx. why not just give high risk/known abusers orals instead of taking the change? anyone that wants to give me more insight into that, please do!

[CritterLover, BSN, RN]

i had a patient like that-- its a psych disorder that causes harm to themselves because of lack of medical attention as a child... munchowsins (bad spelling)..

so coming from canada, things seem to be a bit different here. but many people go home with iv abx? we do have it here, but its not hugely common. most people leave the hospital on oral abx. why not just give high risk/known abusers orals instead of taking the change? anyone that wants to give me more insight into that, please do!

some abx (such as vanc) are only given iv. (well, it can be given po for git infections; but it doesn't get absorbed for systemic infections).

for other abx, it is just that some dx (osteomylitis) really need iv abx. since bone is so poorly vascularized, in order to acheive a high enough concentration to be effective against bone infections, it really takes the iv route.

then there is the whole compliance issue with po abx. iv abx generally come with some sort of home health or close outpatient monitoring, keeping them a little more tightly in the whole health care loop.

i'm wondering if maybe you just tend to keep your patients longer, to get to the point where they can take just po?

[FireStarterRN, BSN, RN]

if they need long term iv abx, then it would be unethical to deny them of that.

true drug addicts are going to get their fix whether they have iv access or not.

and so, no, i have no problems with them being dc'd w/a picc.

leslie

This post sums up my opinion. If they need antibiotics then they need them. Having the PICC will also give them IV access for their drugs that they are going to use anyways, and that will help them avoid skin popping, so it's actually a side benefit. We used to get a lot of herion users in for skin infections secondary to skin popping, so actually the PICC will help avoid that, won't it? Afterall, many advocate clean needles for IV drug users, right?

[traumaRUs, MSN, APRN]

I work in dialysis and I have two patients who use their Permacaths for heroin!!! Can I stop it?? Nope! They have to have dialysis access and they can't have any further surgery for other access because all the sites are used up.

I have had staff ask if I would provide education and a heparin script for them so that they don't ruin their permacaths! Nope...can't do that either as it isn't ethical to enable such behavior.

Very dicey and unfortunately not very clearcut.