Discharging from Hospital with an IJ CVL

[Pkboi24]

Has anyone ever seen this happen? My great aunt got admitted for sepsis and needed to be discharged with IV antibiotics, but instead of putting in a PICC line, they discharged her with an IJ triple lumen. I have never seen this happen before where I practice and I have also asked around and no one else has heard of it either. I'm wondering if I'm right to be upset or if this is something legit that I've just never seen before because I've only ever worked at one hospital.

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[Raryn]

Has anyone ever seen this happen? My great aunt got admitted for sepsis and needed to be discharged with IV antibiotics, but instead of putting in a PICC line, they discharged her with an IJ triple lumen. I have never seen this happen before where I practice and I have also asked around and no one else has heard of it either. I'm wondering if I'm right to be upset or if this is something legit that I've just never seen before because I've only ever worked at one hospital.

Tunneled line or just a regular line?

I discharge people with tunneled CVCs (usually a tunneled IJ) if they have a baseline renal dysfunction that may lead to dialysis in the future, because the PICC is more likely to screw up a vein for a future dialysis site. I've never discharged someone with a regular line... what happens if it gets pulled out?

 

[jdh71]

Has anyone ever seen this happen? My great aunt got admitted for sepsis and needed to be discharged with IV antibiotics, but instead of putting in a PICC line, they discharged her with an IJ triple lumen. I have never seen this happen before where I practice and I have also asked around and no one else has heard of it either. I'm wondering if I'm right to be upset or if this is something legit that I've just never seen before because I've only ever worked at one hospital.

If it wasn't a tunneled line or a PICC, I'd call it malpractice.

I have seen it once, in residency, we got a guy who had been at another hospital that should have known better.

 

[gutonc]

Tunneled line or just a regular line?

I discharge people with tunneled CVCs (usually a tunneled IJ) if they have a baseline renal dysfunction that may lead to dialysis in the future, because the PICC is more likely to screw up a vein for a future dialysis site. I've never discharged someone with a regular line... what happens if it gets pulled out?

Can anyone quote data to support this? I mean, I've heard this same line of s*** from everybody and their dog (but, ironically, not actual nephrologists) as long as I've been in the game (>10y). But nobody has ever proven to me that placing a PICC will ruin possible future vascular dialysis access.

I don't actually give a s*** because I'm an oncologist, and I'll take those renal wussbags down in a heartbeat if it comes to it. But if I can pass on actual data to the residents I teach (without looking it up myself, because that's not happening), then everyone will be happy.

 

[Pkboi24]

Yeah. I asked around other MDs that practice in Houston and NO ONE does this. I'm not sure whether this is the culture of this specific hospital or if it's just this specific hospitalist. Either way, heads will roll.

 

[deleted547339]

I wouldn't call it malpractice, although I would say it's poor practice. Were the patient to get septic, then you could argue it is; but there's no damage at this point.

 

[chessknt]

Can anyone quote data to support this? I mean, I've heard this same line of s*** from everybody and their dog (but, ironically, not actual nephrologists) as long as I've been in the game (>10y). But nobody has ever proven to me that placing a PICC will ruin possible future vascular dialysis access.

I don't actually give a s*** because I'm an oncologist, and I'll take those renal wussbags down in a heartbeat if it comes to it. But if I can pass on actual data to the residents I teach (without looking it up myself, because that's not happening), then everyone will be happy.

http://www.ncbi.nlm.nih.gov/pubmed/22704142
http://www.ncbi.nlm.nih.gov/pubmed/25634154

There isn't a large RCT or anything but it makes sense logically and falls in line with guidelines from various renal/vascular surgery groups.

 

[Pkboi24]

I wouldn't call it malpractice, although I would say it's poor practice. Were the patient to get septic, then you could argue it is; but there's no damage at this point.

I see what you're saying but from my point of view, that's like saying if I accidentally push you down the subway tracks and you miss the third rail and live, then I'm not at fault for manslaughter.

 

[deleted547339]

I see what you're saying but from my point of view, that's like saying if I accidentally push you down the subway tracks and you miss the third rail and live, then I'm not at fault for manslaughter.

I disagree. The argument isn't simply semantics in that people throw the term malpractice around too often. One of the four prerequisites for an act to be considered malpractice is that there has to be undue damage done to the patient - without this, there is, by definition, no act of malpractice.

I think we, as a medical community, should be very, very careful with the term as to not have it be equivalent to a mistake to the general public (maybe too late). I think by throwing this term around, we're incrementally damaging our profession.

Sorry if this seems overly tedious, but I think it's important.

 

[Pkboi24]

I disagree. The argument isn't simply semantics in that people throw the term malpractice around too often. One of the four prerequisites for an act to be considered malpractice is that there has to be undue damage done to the patient - without this, there is, by definition, no act of malpractice.

I think we, as a medical community, should be very, very careful with the term as to not have it be equivalent to a mistake to the general public (maybe too late). I think by throwing this term around, we're incrementally damaging our profession.

Sorry if this seems overly tedious, but I think it's important.

So then are you saying if a medical error is committed but no harm comes to the patient by sheer luck then the doctor has not committed malpractice? I find this a bit hard to accept.

 

[Gadofosveset]

That is correct. Wrrors are made all the time. One is not punished for making an error, one is punished for harming a patient through an error.

You could still be disciplined for the error or bear miss event by some other governing body, e.g. OPPE

 

[chessknt]

So then are you saying if a medical error is committed but no harm comes to the patient by sheer luck then the doctor has not committed malpractice? I find this a bit hard to accept.

This is absolutely true. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628513/

You should be glad it requires harm, otherwise anyone you ordered the wrong labs on or messed up a discharge med could sue you for "malpractice."

 

[deleted547339]

So then are you saying if a medical error is committed but no harm comes to the patient by sheer luck then the doctor has not committed malpractice? I find this a bit hard to accept.

May be hard to accept, but it's definitely correct.

 

[gutonc]

So then are you saying if a medical error is committed but no harm comes to the patient by sheer luck then the doctor has not committed malpractice? I find this a bit hard to accept.

May be hard to accept, but it's definitely correct.

Yup. Mistakes are made on a daily basis, by every physician, in every specialty. That's life. 99.999...% of them do not cause any harm.

Here's a quote from the article linked to above:

Medical malpractice is defined as any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient.

The bold is mine. Not only do you need to do some crazy s***, but there must also be (otherwise avoidable) harm as a result in order to meet the legal standard of malpractice.

 

[Hernandez]

How much longer did they need abx for? Picc lines overall infection rates are similar but many studies suggest it takes longer to develop than a central line, if appropriate home health taking care of line was arranged and it wasn't going to much longer id be ok with a cvc

 

[Pkboi24]

How much longer did they need abx for? Picc lines overall infection rates are similar but many studies suggest it takes longer to develop than a central line, if appropriate home health taking care of line was arranged and it wasn't going to much longer id be ok with a cvc

2 weeks of antibiotics. They expected her to have an IJ in for 2 weeks. My aunt also got no information as to when it should be taken out or where she should go to have it removed. Luckily, I told her to take her mom back to the hospital and now she has a PICC.

I've never experienced a true "OSH" until this moment.

 

[jdh71]

I don't think discharging someone with a IJV central line is a "mistake". And yes small errors are made on a regular basis by all physicians. The patient here was knowingly sent out with a central line. Even with ****ty home health I'm not cool with this. This patient gets a line infection and it's indefensible. Or let me put it this way. The plaintiff 's attorney won't have much trouble finding a guy like me with similar opinions on the matter.

So you can all get pendantic about legal terminology all day long but this case is a problem.

 

[Doctor Bob]

I've never discharged someone with a regular line... what happens if it gets pulled out?

<shrug> Hold pressure...

 

[tartesos]

Has anyone ever seen this happen? My great aunt got admitted for sepsis and needed to be discharged with IV antibiotics, but instead of putting in a PICC line, they discharged her with an IJ triple lumen. I have never seen this happen before where I practice and I have also asked around and no one else has heard of it either. I'm wondering if I'm right to be upset or if this is something legit that I've just never seen before because I've only ever worked at one hospital.

Someone forgot to take that out!
Lol
It happened to a friend of mine in residency and he, myself and the nurse went after work to patient house and removed it, with a 1000 apologies. On the plus side it gave us a legit reason to visit marcy Abe projects in NYC .

If there was plans for atbs later, it may have been an oversight of case manager and nurse...

I'm sorry for your auntie!