PICC line question

December 31, 2002

Hi everyone! I have a question for those of you that have had PICC

lines. I had posted a few weeks ago about my son Brennen and his

sinus infection, and that his IgG levels where low and he has had no

response to the prevnar. Well we put in the PICC line 10 days ago

and on Sunday the line got clotted so we went to the ER and the got

it unclotted but they had loosend up the tape quite a bit so when I

got home and started his antibiotics the next day the PICC line came

about 4 inches out. I called the immunologist and they sent us back

to the ER to see where the line was. They did a chest X-ray they

said the line was still in his arm but they lost it at about his

shoulder. They called the PICC team and all of them where out untill

Jan. 2. so they sent me up to adult radiology and the radiologist

looked at the site and literley taped it back up, and it didn't

accure to me untill I got home that it was NOT a sterile dressing

change. So here are my questions. 1. Is it okay if the Picc is only

part way in his arm, and 2. Is there a chance that he will get an

infection from the unsterile environment. I am so frustrated right

now. My immunologist is out of town untill Jan 6 and I am a nervous

wreck. I have some ER docs say it needs to be pulled, and a new one

put in. The radiologist said it was fine. My home health care nures

said that it should be okay, but the line is still clotting and very

sluggish when we run his meds. Any advice would be really

appreciated!

Thanks,

December 31, 2002

Hi ,

My daughter had a PICC line when she was on IV antibiotics for

four weeks with endocarditis. Basically they should be having you flush with

heparin and saline periodically to prevent clotting of the line. I presume

they already did run a prothrombin time to verify that you son does not have

a clotting disorder. When we had the line put in we had it done by an IV

Nurse at the hospital (who only does IV's on children and has special

certification for doing all kinds of special lines) The Nurses and doctors

who are certified in placement of the PICC lines would probably be the best

to advise you on whether the placement is alright. But it sounds like they

are not available right now. My understanding was they want to put it in a

deep as possible because the veins closer to the heart are much less fragile

so infiltration is less likely. I was told that less deep wasn't as much of

problem as too deep. However, the specialized nurses would know more about

other possible implications.

My understanding was that the dressing on PICC lines was supposed to be

sterile and changed in as clean a manner as possible-- more betadine and

alcohol swabbing, nurse wore sterile surgical gloves when touching anything

that might contact the line site when changing the dressing--she even wore a

mask because the kind of endocarditis had was from a bacteria

commonly found in the mouth. Sterile Tegaderm dressing over the whole thing.

I think everything but the mask was sort of standard procedure for all PICC

lines for the IV nurse--but I don't know if there are different standards at

different hospitals. Whether it makes an actual difference to your child is

what is important -- like did the radiologist touch the open line site with

his finger without washing his hands or wearing sterile gloves? I'm guessing

from the results of the chest x-ray that the radiologist is saying that the

line is not kinked or placed too close to the heart so that your child is not

in any danger from the placement of the line.

I would feel uncomfortable that the dressing was not done in a " sterile "

manner and would review exactly what the radiologist did as far as the

dressing change with the covering immunologist (person available in

emergencies) or infection control director at the hospital to see if he/she

thinks it will make a difference--given that your child has an immune

deficiency I wouldn't like taking chances.

Hope this helps and good luck.

Martha (mom to Chrissy IgA deficiency etc.)

December 31, 2002

-

My daughter Abby has a PICC now. They first put in a mediport. But that

clotted after less then 24 hours. They tried to unclot it but it didn't

work. So they pulled the line and put a PICC in her chest and was put under

for that.

I would be uncomfortable that the dressing was an unsterile one. And that

the meds don't go through at the rate it should. Does your immuno have a dr

on call for him or her. It may be worth trying to call. Or maybe a trip to

the ped who can then call someone. Just a thought.

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December 31, 2002

Hi ,

I am a home health nurse and am the director of a home health agency. Our

agency is on call 24 hours per day just for this reason. Your home health

agency needs to come and assess the line and determine that it is

functional. Then put an appropriate dressing on it. We are paid to maintain a

line. Not necessarily to put it in but to maintain it and the meds ordered by

your doctor. If your agency/nurse is not willing to then I would call your

insurance company first thing on Thursday to let them know. If a company is

being paid to have a skilled n urse come out and assess , teach and maintain

a site with meds then that is what they were contracted to do. NO MATTER IF

there is a HOLIDAY. Secondly, the hospital has a 24 hour IV team which is

required to have a hospital. They need to make sure the PICC line is in place

and verify that the Xray has been read. Are you in a small town? I know we

had trouble in the past with a PICC line and drove 2 hours to Seattle to the

Childrens Hospital to have it reinserted. Not just anyone can reinsert

especially with kids but ....maintenance is a different story. As far as the

dressing . It is a sterile dressing change procedure. It should be covered

and secured. so that the sight is not exposed. Usually an opsite or tegaderm

is adequate. Hope this helps to clarify who is responsible for what. ERs have

very little knowlege about PICC lines but they should be able to change a

dressing. Unfortunately, medicine has become so incredibly compartmentalized

that only a " PICC team know anything " GIVE ME A BREAK

BARBIE ( Lucas, 7, CVID, IVIg, Bipolar etc.)

December 31, 2002

,

My home health care nurse came in this morning and gave it a

sterile dressing change. I talked to immunology. They are saying

Jan. 2 is when I can speak to the picc line team, and that its not an

emergency. I am not really comfortable with the whole situtation,

but I see no redness or swelling at the site. All looks good so far.

I am keeping my fingers crossed. How long is Abby going to have her

PICC line. I hope things are going well for you guys. Have a happy

New Year.

January 1, 2003

I am so sorry you are going through this! Kody had a picc line when he had

his osteomylitis in his knee. His first one broke (the little doohicky that

you screw the antibiotic into snapped right off! Blood started pouring out

because the clamp had somehow come undone while Kody was playing, and it was

a terrifying moment to say the least. I kept thinking, what if that happened

when we were asleep?????) so it was replaced and this time in the other arm.

The first one was also showing early signs of infection so it would have

been replaced anyhow. The second one didn't last long either, I think only

about a week or so, and it went bad, so again we replaced it. The third one

barely held on to the end of his antibiotic regimine. You do have to be

careful with the sterile dressing, you have to flush with saline and then

with heprin to avoid clotting. I think Kody's kept going bad because of his

allergic reactions to tape adhesive, plastics, and latex. His never pulled

out that far or that easily maybe only a centimeter or so. But it is

irresponsible of the hospital not to have someone available to take care of

any picc line problem that may arise. When Kody's broke, we did have to wait

until Monday to get a new one, it broke on a Saturday, so the home health

care nurse pulled it out, and inserted a regular IV in his hand to continue

meds that way until Monday. My point is, I know how picc's can be so scary,

and it is all new territory for you. I am praying that it all gets taken

care of soon for you!

Diane, Mom to Kody

Please feel free to visit my website for parents of children with multiple

special needs :

www.geocities.com/schmidtzoo/SNAK.index.html

-- PICC line question