Of course you do, Tim. But this is not policy. This is our department, using (brace yourself) critical thinking skills. If the nurse (or Rad Tech, or doc, etc.) pulls out the line, we replace the line as appropriate. The thing is, this works for us. We get the sitter, the pt gets the needed line, and is much safer.
Repeatedly exposing the endothelium to insertion and removal of lines is unreasonable. And expensive.
Leigh Ann
-----Original Message-----
From: Tim Talbert <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Sent: Sat, 20 May 2006 10:47:42 -0700
Subject: Re: How many times?
I think a blanket rule like this is unreasonable. Stuff happens. Tim >>> <[EMAIL PROTECTED]> 5/19/06 >>> Randy: If a pt pulls out a PICC (or other line, and they want it replaced with a PICC), we refuse to replace it until they either restrain the pt or get a sitter. Obviously, sitter is the first choice, and is usually what we get (unless the pt is in ICU). At that point we replace the line (once). Part of protecting the pt is not destroying vessels with repeated line placements. Leigh Ann -----Original Message----- From: [EMAIL PROTECTED] To: Tim Talbert <[EMAIL PROTECTED]>; [EMAIL PROTECTED] Sent: Fri, 19 May 2006 18:24:33 +0000 Subject: Re: How many times? Very good answers from all. Couple of things. 1. He is a Nursing Home Resident. 2. State frowns on Restraint use even if it is in the best interest of the resident but the main issue is the Facilities lack of understanding of the laws regarding restraints and the lack of staff to follow proper protocol. 3. I understand some people's statement's to do what is right for the patient and place the PICC. But, some would argue that if there are alternative medications to treat the infection i.e. PO then doing what is right would include preventing a possible embolus of the catheter if resident cuts or breaks the line. Plus the cost is an risk vs. benefit issue. 4. Arm sleeves, Kerlix, and long sleeve shirts have been used. I am not at the facility 24 hours but I have educated and demonstrated the use of these possibilities. 5. Liability issues. As we all know, we are taught liability issues and teach liability issues. I am not sure that I am for sure liable if the catheter breaks and embolus or something happens to the resident to tell you the truth. My lawyer says not to do it if it goes against my better judgement. But, as some have suggested we have no real liability for this. Are you sure? Are you willing to hand over the cash to defend yourself if you believe this? Here in this State there are signs on the side of Highways asking "Is your family member is in a Nusing Home and if so are you happy with your care?" Call 1- 800-555-&*&* Should we take the risk. My former business insurance provider raised my rates to $50,000 a year due to attorney's like these just to get rid of me as a policy holder. Just stating the facts as I see them. By the way Gail, great idea about the Tunnelled Cath. Had a patient pull out her Hickman yesterday. OUCH! Thanks everyone, I new I could count on you!!! Randy -- Randy Ross R.N., B.S.N. IV Nurse Consultant, President & C.E.O. IV's Etc... LLC Vascular Access & Consulting Ph: 317-541-6463 Fax: 317-894-7709 Email: [EMAIL PROTECTED] Website: www.IVsEtc.com -------------- Original message ---------------------- From: "Tim Talbert" <[EMAIL PROTECTED]> > Can more be done to cover and protect the catheter while not in use? > Tape it up good, use an Ace wrap or three, put on a long sleeve shirt > and sweater? > > Tim > > >>> <[EMAIL PROTECTED]> 5/19/06 >>> > Question for the group. > I am seeking advice from anyone and everyone. How many times would you > re-insert a PICC line in a resident that has pulled out 5 PICC lines in > the last week and a half? He is an elderly resident of a Nursing Home > so restraints are not an option. (Why? The facility will not use them.) > He is a former locksmith and thinks his PICC's are locks that need to > be fixed. He also thinks his Vinyl Lap Buddy is a Lap Dog. He is so > very confused and he has a Month of Vancomycin therapy. I have > suggested with consultation with a pharmacist that Zyvox be given PO. > The Infectious Disease Doctor who said to try once more before switching > is now refusing to switch. He his adamant that the line be replaced. > > > -- > Randy Ross R.N., B.S.N. > IV Nurse Consultant, > President & C.E.O. > IV's Etc... LLC > Vascular Access > & Consulting > Ph: 317-541-6463 > Fax: 317-894-7709 > Email: [EMAIL PROTECTED] > Website: www.IVsEtc.com > > > > Notice from St.Joseph Health System: > Please note that the information contained in this message may be privileged and > confidential and protected from disclosure. > Notice from St.Joseph Health System: Please note that the information contained in this message may be privileged and confidential and protected from disclosure.
