Good attitude Nancy
In 1998 did RN's think they would be using ultrasound and
scalpels to place PICC lines?
Some don't think they should be using them
today
I believed it to be a reality in 1998. and common by
2010
If you are not using ultrasound at this point on all
insertions of central lines across the board you have missed the patient safety
bus. Get on it or get off and do us all a favor so we can move
forward. I am tough!!!! Ultrasound is standard for a
Interventionalist to use for vascular access. I wonder why? They are
patient safety conscious.
The new vascular access nurse is ready for the jugular
soon! I think we can tunnel these small bore catheters in the
future. Far fetched I doubt it.
Medicare pay for performance is around the corner and I
eagerly await the changes with the MMA act. If you do not know what the
MMA act is (medical modernization act from congress) I suggest reading up on it
www.cms.gov. It will change the whole
face of healthcare in 2008.
Kathy
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From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Nancy
Moureau
Sent: Wednesday, August 16, 2006 8:40 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: RE: tunneled small-bore CVCs
Sent: Wednesday, August 16, 2006 8:40 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: RE: tunneled small-bore CVCs
Tunneled PICCs
are the up and coming thing, primarily reimbursement driven. Lynn mentioned
having a devices designed for that purpose, tunneled insertion into the IJ, well
isn't that what we all do over time, help with the development of such devices?
(truly we already have IJs but this is a different twist). Hickman catheters,
Broviacs, Hohn etc were all catheters developed from someone's idea and usually
when another catheter existed that required some modification and then
miraculously the catheter acquired another name (most common branded with the
developer's name). Right now we may call them IJ PICCs, tunneled PICCs, SBTC
small bore tunneled catheter or whatever, later we will have devices designed
for this purpose. Don't you remember when PICCs were long lines, perc lines,
piclets, pics and pic-cs and so many other names? Usage has to occur before
development. How can we use a line developed for a particular purpose if no one
has thought to use it yet? We are on the cutting edge of vascular access
development and have the privilege of seeing new and different things. My goal
is to help develop the ideal device. What would a perfect PICC look like, how
about a perfect IJ? Envision it and it can happen
Nancy
Nancy Moureau, BSN,
CRNI
PICC Excellence,
Inc.
888-714-1951
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway
Sent: Wednesday, August 16, 2006 9:33 AM
To: [EMAIL PROTECTED]; Nadine Nakazawa; [EMAIL PROTECTED]
Subject: RE: tunneled small-bore CVCs
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway
Sent: Wednesday, August 16, 2006 9:33 AM
To: [EMAIL PROTECTED]; Nadine Nakazawa; [EMAIL PROTECTED]
Subject: RE: tunneled small-bore CVCs
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, OCN
PICC Program Coordinator
Stanford University Hospital and Clinics
Stanford 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
