Tunneling for a subclavian or jugular catheter is not a new
concept. There have been several publications about this. But this
should not be confused with a tunneled and cuffed catheter.
Nurses have been placing PICCs through the external jugular for
some time now. Several years ago, there was an article in JVAD about
this.
In my opinion, a catheter that is designed for insertion at this
site is more appropriate than using a PICC and adapting it. This
includes a Hohn catheter.
We have also had a discussion on the listserv in the past about
whether the EJ is considered to be a peripheral vein. I would say that
veins of the neck are peripheral veins. EJ is a superficial peripheral
vein while the IJ is a deep peripheral vein in the neck.
The infection risk for any catheter placed in the neck is greater
than the PICCs in the arm because of the density of skin flora and the
difficulty in maintaining an intact dressing.
So this would only be for those situations where nothing else is
available.
As far as a name, why do we need to start using a different name
for this placement? Seems to me this would add to the confusion. It
also adds to the confusion when the external catheter segment is
stamped with "PICC" and it is coming from the lower neck.
That is why it would seem more appropriate to use a Hohn designed for
this site. Lots to consider with this one! Lynn
At 12:52 PM +0000 8/16/06, [EMAIL PROTECTED] wrote:
I have seen such a line. When I first saw the patient I was quite perplexed. It was a dialysis patient with a dialysis catheter in Right subclavian. About an inch away from the insertion site of the dialysis cath, there was a PASV catheter inserted. Being a PICC nurse I know the different PICC catheters, my first thought was: " why did they use a PICC cath as a subclavian.?" Then I looked at the CXR.......the dialysis was placed Subclavian, but the "PICC" apparently was tunneled because the path sent up the neck and then down the jugular!!! I wonder who was the first person to 'invent' using a PICC in the IJ. I have heard MD call it an IJ PICC. Mostly these are nephrologist.
If this is going to become more prevalent, we need a better name for it, in my humble opinion. First of all this is not a "peripheral" site. Secondly, would the dwell time be as long as a true PICC?? I think not because of the insertion site being in the dirtier chest. Isn't this how a HOHN catheter is placed??
One thing for sure......I do admire peoples ingenuity in getting vascular access for those TOUGH ONES!.
--
Susan Schuetrumpf, CRNI
VASPRO
Atlanta, GA
cell-404-606-1194
-------------- Original message --------------
From: "Nadine Nakazawa" <[EMAIL PROTECTED]>
Does anyone have a good name for these "small bore tunneled CVCs" that can be placed into the IJ with a short tunnel, that are 6 or 7 Fr in size? Tim or Ann: What do you call these lines? Especially if they are a PICC that has been trimmed and used in the IJs for patients with no decent vasculature in the arms for a regular PICC??
Our IR Chief feels that if the PICC team refers them a patient where we failed to get the PICC in, they will likely have the same troubles. Bad veins are bad veins. He wants to start putting in these lines when we refer them to IR for a failed PICC insertion. I think it dovetails very well with earlier discussions about all the bad vasculature out there. It's getting to be a real problem.
Our numbers are excellent and we seen to only refer the truly difficult access situations.
Nadine Nakazawa, RN, BS, OCNPICC Program CoordinatorStanford University Hospital and ClinicsStanford University Medical Center
--
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
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
