We use full sheet drapes from head to tow with our central line insertions. Jose
Quoting Ward Gina <[EMAIL PROTECTED]>: > I too found it interesting that the intent of the article was to evaluate the > efficacy of the chlorhexidine sponge and ended up comparing picc line > infections to standard central lines. I think they got a little of track! > > regarding ; 100k lives campaign; for maximum barrier protection ; do you > all use full sterile barriers from the patients head to toe as is the > definition or; sterile drapes on upper chest and arm area and bottom arm? > > thanks for all the input! Gina Ward > > ________________________________ > > From: Peng, Kathleen [mailto:[EMAIL PROTECTED] > Sent: Tue 12/6/2005 3:18 PM > To: [EMAIL PROTECTED]; Ward Gina; Bell, Roberta M. ; > [EMAIL PROTECTED] > Cc: [EMAIL PROTECTED] > Subject: RE: [vascular] Re: Need help with Dr who debates picc lines > > > I just looked at the article again and it states " Methods: PICCs inserted > into the antecubital vein in two randomized trials from 1998 to 2000 were > prospectively studied; most patients were in ICU." I do stand corrected in > that it also says one study was to evaluate the chlorhexidine-gluconate > sponge dressing and the other to evaluate 1% tincture of chlorhexidine. > > Kathleen > > ________________________________ > > From: Lynn Hadaway [mailto:[EMAIL PROTECTED] > Sent: Tuesday, December 06, 2005 2:02 PM > To: [EMAIL PROTECTED]; Ward Gina; Bell, Roberta M. ; > [EMAIL PROTECTED] > Cc: [EMAIL PROTECTED] > Subject: RE: [vascular] Re: Need help with Dr who debates picc lines > > > I am not sure about that and don't recall if the article stated that. Sorry, > Lynn > > At 12:49 PM -0600 12/6/05, Peng, Kathleen wrote: > > Also, wasn't the data in the study actually from the late 1990's before > the > use of chloroprep and maximum sterile barriers? > > > > Kathleen Peng, RN > > Nutrition Support > > Presbyterian Hospital of Dallas > > 214-345-7468 > > > ________________________________ > > From: Lynn Hadaway [mailto:[EMAIL PROTECTED] > Sent: Tuesday, December 06, 2005 11:19 AM > To: Ward Gina; Bell, Roberta M. ; [EMAIL PROTECTED]; > [EMAIL PROTECTED] > Cc: [EMAIL PROTECTED] > Subject: [vascular] Re: Need help with Dr who debates picc lines > > > First, the article you are referring to is only one study of this > issue. It > is the first one to report this data. It is also data that was originally > collected for other studies and the authors used it to extrapolate the PICC > infection data. > > > CRBSIs occur primarily from 2 reasons - skin flora and hub > manipulation. A > PICC has a much lower risk of infection because the skin on the arm is dry > skin with a smaller number and fewer types of organisms when compared to the > oily skin of the neck. So that factor reduces the risk. Skin is considered > the primary source of infection in short term catheters. > > > Hub manipulation would be the same risk factors for all central lines - > no > difference there. This is considered the primary source of infection for > long-term catheters. > > > You may have to go back to using PICCs in only those patients that would > have gotten a nontunneled central venous catheter anyway. A PICC offers far > less risk on insertion than a subclavian or jugular inserted line. > > > You can also rely on the data about pH and osmolarity and the risk of > permanent damage to peripheral veins. > > > Finally I would work on implementing the central line bundle from IHI - > www.ihi.org - and their Save 100,000 lives campaign. This is designed to > reduce CRBSI regardless of what type of catheter is being used. Collect your > outcome data and document what you are producing. Zero rates of CRBSI should > be the goal and some are now considering this to be a reachable goal. Good > luck, Lynn > > > > At 10:18 AM -0500 12/6/05, Ward Gina wrote: > > > We have recently started a PICC program at our rural 101 bed > hospital. > Originally our Pulmonologist was excited and really wanting us to get this > process started. It took us a while and now we have been up and running for > 2-3 months and have done about 30 piccs total. > > Problem is, recently he read an article in the "chest" > magazine about how > PICCs have no less infection rate than central lines, and to make a long > story short he no longer encourages the use of PICC lines. He feels they are > just increasing the risk of getting a blood stream infection. He turns down > many requests for Physician inserted Central LInes for the same reason. He > openly says he would rather have the pt deal with poor peripheral access and > multiple sticks than to increase the risk of a blood stream infection. He > feels they are only good for long term O.P. antibiotic therapy and then even > when that happens and we ask; he says if they have good veins just stick > with the I.V. peripherally. > > I have discussed our outcomes, and our criteria for patients we > put them in > on, and how only myself and the other R.N. who insert them do the dressing > changes etc. He still feels very strongly about it. He does rarely put in > a request for us to put in a PICC when there is absolutely nothing else and > all the "expert" I.V. nurses have tried but thats it. > > The Doctors as a whole dont want this to be a proactive > approach now but a > reactive approach after hearing his input. > > Any help or suggestions? > > Thanks, Gina Ward > > -----Original Message----- > From: [EMAIL PROTECTED] > To: [EMAIL PROTECTED] > Cc: [EMAIL PROTECTED] > Sent: 11/29/2005 7:06 PM > > Subject: RE: [vascular] SVC/IVC tip termination > > Thanks a bunch Angie! > > Tuality, OR? > > I took my first PICC class there Dec 2001~~~! > > Robin > > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] > <mailto:[EMAIL PROTECTED]> ] > Sent: Tue 11/29/2005 12:19 PM > To: [EMAIL PROTECTED] > Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED] > Subject: Re: [vascular] SVC/IVC tip termination > > > > Here are several acticles that may be helpful: > Lum, P. and M. Soski, Management of malpositioned > central venous > catheters. > Journal of Intravenous Nursing, 1989. 12(6): P 356-364 > > > This article includes mdeical references about > neurological > problems > associated with caudally directed catheters. > > Cohn, D., et al., Factors predicting subcutaneous > implanted > central venous > port function: Gynecologic Oncology, 2001. 83: p. > 533-536 > Collier, P., et al., Cardiac Tamponade from Central > venous > catheters. > American Journal of Surgery, 1998. 176: p. 212-214 > Collin, G.R., A.S. Ahmadinejad, and E. Misse, > Spontaneous > migration of > subcutaneous central venous catheters. The American > Surgeon, > 1997. 63(4): > p. 322-326 > > We obtained this list from Lynn Hadaway when dealing > with a > surgeon who > said it was ok to use the port even thought the the > catheter tip > had > migrated up into the IJ. After much ado the the tip was > repositioned by > interventional radiology and the port was not used > until this > was done. > Angie Sims RN, CRNI, OCN > > > > > "Bell, Roberta > > M." To: > <[EMAIL PROTECTED]> > > <[EMAIL PROTECTED] cc: > <[EMAIL PROTECTED]> > > alth.org> Subject: > [vascular] SVC/IVC tip termination > > > > 11/29/05 07:50 > > AM > > Please respond > > to vascular > > > > > > > > > > Hello all, > > I am in the process of implementing PICC policies as > well as > rewriting > central line policies and I am being questioned > regarding tip > placement. > This nurse has had a few occasions where a Subclavian > line is > placed but > the tip terminates in the IJ (goes up), and the > physician has > ordered that > it be used anyway. One occasion was actually fluid > resuscitation. My > question to you all, is there anyone who knows of > articles for > me to site > that this is not best practice? > > Thanks Loads! > > Robin Bell RN > Clinical Coordinator ICS/OPM > Sutter Lakeside Hospital > Lakeport, CA > > > > > ====================================================================<<< > Whatever you Wanadoo, click below: > > http://ads.smartgroups.com/adclick/CID=000000b7c79a99a500000000 > <http://ads.smartgroups.com/adclick/CID=000000b7c79a99a500000000> > > -- > If you want to share pictures, use the calendar, or > start a vote > visit http://www.smartgroups.com/groups/vascular > <http://www.smartgroups.com/groups/vascular> > > To leave the group, email: [EMAIL PROTECTED] > E??ยบ? > > > > > ====================================================================<<< > Whatever you Wanadoo, click below: > > http://ads.smartgroups.com/adclick/CID=000000b7c79a99a500000000 > <http://ads.smartgroups.com/adclick/CID=000000b7c79a99a500000000> > > > ====================================================================>>> > -- > If you want to share pictures, use the calendar, or > start a vote > visit http://www.smartgroups.com/groups/vascular > <http://www.smartgroups.com/groups/vascular> > > To leave the group, email: [EMAIL PROTECTED] > > Eh?? 0f > ? o{iz\~h"wpvh > > > > > -- > > Lynn Hadaway, M.Ed., RNC, CRNI > Lynn Hadaway Associates, Inc. > 126 Main Street, PO Box 10 > Milner, GA 30257 > http://www.hadawayassociates.com > office 770-358-7861 > > > > Report abuse > <http://www.smartgroups.com/text/abusereport.cfm?gid=797122&mid=21885> > > > <http://ads.smartgroups.com/adclick/cid=000000c0c79a99a500000000> > > > If you want to share pictures, use the calendar, or start a > questionnaire > visit http://www.smartgroups.com/groups/vascular > > > To leave the group, email: [EMAIL PROTECTED] > > Report abuse > <http://www.smartgroups.com/text/abusereport.cfm?gid=797122&mid=21886> > The information contained in this message and any attachments is > intended > only for the use of the individual or entity to which it is addressed, and > may contain information that is PRIVILEGED, CONFIDENTIAL, and exempt from > disclosure under applicable law. If you are not the intended recipient, you > are prohibited from copying, distributing, or using the information. Please > contact the sender immediately by return e-mail and delete the original > message from your system. > > > > -- > Lynn Hadaway, M.Ed., RNC, CRNI > Lynn Hadaway Associates, Inc. > 126 Main Street, PO Box 10 > Milner, GA 30257 > http://www.hadawayassociates.com > office 770-358-7861 > > <http://ads.smartgroups.com/adclick/cid=000000bdc79a99a500000000> > > > If you want to share pictures, use the calendar, or start a questionnaire > visit http://www.smartgroups.com/groups/vascular > > > To leave the group, email: [EMAIL PROTECTED] > > Report abuse > <http://www.smartgroups.com/text/abusereport.cfm?gid=797122&mid=21887> > > > The information contained in this message and any attachments is intended > only for the use of the individual or entity to which it is addressed, and > may contain information that is PRIVILEGED, CONFIDENTIAL, and exempt from > disclosure under applicable law. If you are not the intended recipient, you > are prohibited from copying, distributing, or using the information. Please > contact the sender immediately by return e-mail and delete the original > message from your system. >
