So Nadine, let me see if I understand what you are saying. Your most
important point is the fact that the catheter is tunneled making it
easier to secure and remove.
My understanding of what Gail S said, and what I have read in
published literature is that any catheter can be inserted with a
tunnel and she mentioned Hohns.
So I am still confused about what is actually needed that we don't
have. Maybe I am just a little slow today! Thanks,Lynn
At 2:10 PM -0700 8/16/06, Nadine Nakazawa wrote:
Tell your group that I just met with the Chief of IR at Stanford,
"Rusty" Hofmann and he gave me that very article! This is what he
wants to do for all PICC referrals the PICC team sends them. He
says that we are only sending the MOST difficult vasculature pts to
them,and if we can't get a PICC in then they have struggled for
hours to get them in and he strongly feels we aren't doing what is
best for patients. Anyway, we are going to start dong this (IR
first, PICC team later) once I get all the education out there about
this "new" line.
I disagree with Lynn. Although it is tunneled, it willl look
different as they will be using a short tunnel with a small bore , 5
or 6 Fr PICC, without a cuff. It is easier to remove because it's
small with no cuff, easier to insert. A Hohn does not have a
tunnel (as I recall) and is usually inserted percutaneously into the
subclavian or IJ. This SBCC or tunneled jugular SMCC will require
some staff nurse and community education to get nurses comfortable
with it's location, higher infection rate due to skin but less with
the tunnel, how to remove it, how to secure it, etc.
Nadine
From: "Nancy Costa" <[EMAIL PROTECTED]>
To: "Nadine Nakazawa" <[EMAIL PROTECTED]>, [EMAIL PROTECTED]
Subject: Re: tunneled small-bore CVCs
Date: Wed, 16 Aug 2006 08:53:56 -0400
Hi Nadine,
Our radiology group calls them SBCC - small bore central catheter.
In fact they have published this in Radiology. These are mostly
used for renal patients.
"Tunneled Jugular Small-Bore Central Catheters as an Alternative to
Peripherally Inserted Central Catheters for Intermediate-term
Venous Access in Patients with Hemodialysis and Chronic Renal
Insufficiency"
Sassadeusz, Trerotola, Shah, Namyslowski, Johnson, Moresco, and Patel
Radiology 1999; 213:303-306
Nancy Costa CRNI
----- Original Message -----
From: Nadine Nakazawa
To: [EMAIL PROTECTED]
Sent: Tuesday, August 15, 2006 10:29 PM
Subject: RE: tunneled small-bore CVCs
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, OCN
PICC Program Coordinator
Stanford University Hospital and Clinics
Stanford University Medical Center
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Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
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