Senior Capstone Project

[snowstamper]

I am currently working on my Senior Capstone Project. I am focusing on lack of criteria/ protocol for when to pull PICC access. Current practice at my facility and from my research is to either pull access "when it is no longer needed" or at discharge. I am working to theoretically implement a protocol that would the nurse could follow that would facilitate initiating communication with primary care providers to remove access. This is what I have come up with and I was hoping to receive some feedback. Thank you.

P- Patient Status

I- Intravenous Antibiotics

C- Concluded PN/TPN

C- Clearance for Discharge

Patient Status is assessing whether the patient is currently stable or unstable

Intravenous Antibiotics is if the patient is currently receiving more than one IV antibiotic

Concluded PN/TPN is that the patient is either on a PO diet or a PEG tube is in place

Clearance for Discharge is if the patient is scheduled to be discharged in 48 hours or less

If the patient is Stable, receiving no more than one IV antibiotic, is on a PO or tube feed protocol, and is scheduled for discharge in less than 48 hours, then the nurse could contact the physician and inquire about PICC removal.

What do you guys think?

Thank you!

[Double-Helix, BSN, RN]

This is a big undertaking. Kudos for being ambitious. I do want to let you know that changing policy and developing any kind of tool for widespread use is a task that will require more than just a nursing student. Tools like this have to be proven to be valid and consistently applied. You'll want to get some of the staff from the hospital on board if you really want to take this beyond a theoretical project.

Some points about PICC line indications:

- It's not the number of antibiotics that require a PICC line, but the frequency and duration. Also of consideration is the kind of antibiotic. Some, like vancomycin, are more damaging to veins, and in a patient with poor peripheral veins may blow through so many standard peripheral IVs that a PICC is a better option.

-Patients may be discharged home with PICC lines for long term antibiotics or other medical therapy. Clearance for discharge is sometimes, but not always an indication for removal of access. My other concern is that, sometimes, the patient may not be discharge ready for one reason or another, but no longer needs a PICC line. Making "clearance for discharge" a necessary criteria may miss those patient's who still require admission but no longer need central access.

-A patient with poor peripheral access (think veins damaged by chemotherapy, or vasculitis, etc.) may be candidates for PICC lines for that reason alone.

- Blood transfusions, administration of concentrated electrolytes, and need for frequent blood draws are also indications for a PICC line that aren't addressed in your tool. Here's a quick list of PICC line indications- Why Choose a PICC

I think you've got a good start, but your tool requires some tweaking. How are rounds conducted in this hospital? Does the nurse participate in bedside rounds with the physician? I wonder if a more attainable goal might be to get the staff nurses to encourage a daily discussion with the physician during rounds to assess the continued need for central access. The tool you develop can be used by the nurses to facilitate the discussion.