Wow! What a scenario! Let's put it this way: Say the patient develops
a CRBSI and ends up in the ICU with septic shock and renal failure? what
if she lives and ends up a vegetable? What if she has small children and
she's the only parent supporting them? Who would the family sue? Who
would they blame for leaving in a line when the CDC and other major
orgainizations way to evaluate the line every day and take it out when it is
no longer needed???
I would definitely remove it at the next dressing change and nicely explain
to the patient that if she needs a line again, she can get one but only with
clear indication that she needs it and with a physician's order.
There is a real risk in leaving it in even though she has been "abandoned"
by her medical team (other than home infusion).
I'd have at least two nurses go in for the PICC removal. You guys deal
with some tough situations!
Nadine Nakazawa, RN
From: "Heather Nichols" <[EMAIL PROTECTED]>
To: "Ann Williams" <[EMAIL PROTECTED]>, "Cindy Schrum"
[EMAIL PROTECTED]>
CC: "IV Listserv" <[EMAIL PROTECTED]>
Subject: Re: Got order?
Date: Sat, 30 Sep 2006 15:49:54 -0400
You better fire me to then, cause I'm right with ya Cindy. I would have
pulled the line too. We (the Vascular Access Team) here at the big ole U
are the only ones in the hospital that can pull a line without a doc's
order, but we better have a darn good reason to back it up. Sounds like Ann
had that reason to me. Whats really weird though is that this is usually
the other way around. ;-)
Heather Nichols RN BSN CRNI
Infusion Services
University of Louisville Trauma Institute
530 S. Jackson St.
Lou. Ky. 40202
(502)562-3530
>>> "Cindy Schrum" <[EMAIL PROTECTED]> 9/29/2006 7:43 PM >>>
Ann, I'm afraid the temptation to put the patient first and pull the
stinking line before she developed a CRBSI would be overwhelming for
me. It's not only reasonable, but prudent and just plain the 'right
thing to do'.
Can't believe the doc would desert his patient like that. OK, I can.
Fire me.
On 9/29/06, Ann Williams <[EMAIL PROTECTED]> wrote:
>
>
>
> Hi all!
>
> Here's a good scenario for you*.we have a pt that ever since accepted to
our
> Home Infusion/home care services, we have had difficulties with the
ordering
> MD, to the point that he doesn't want to sign the orders. We managed to
get
> original orders signed, but now she has been running around with a PICC
and
> off her antibiotics for 2 weeks. Every doc that has had any kind of
> involvement with her, either hospital, wound care clinic, surgeon, or IC
> doc*all refuse to give the order for PICC dc. Her family doc won't give
it
> because he hasn't seen her in forever. We have suggested 'tripping'
over
> the line and*'opps!'
>
> I am not used to pulling a line without an order, but in this case am
> thinking it is a reasonable thing to do. We can't say the 'patient' is
> non-compliant*she is very compliant. But we need to get that line out
> before she develops complications from it. Yes, we have tried all the
usual
> approaches, such as explaining to the docs WHY we need to remove it
since it
> isn't being used, but WE seem to be the only ones wanting to take
ownership
> of it!!
>
> Any thoughts/suggestions? Just a typical Friday here! Hope you are all
> having a good one, and just remember the weekend is near*.but we already
> have 3 going home tomorrow!! : (
>
> Best, and thanks in advance!
> ann
>
> Ann Williams RN CRNI
> Infusion Specialist
> Deaconess Home Services
> 600 Mary St.
> Evansville, IN 47747
> 812-450-3828
> 812-450-4665 FAX
>
>
>
>
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