The products are already out Manufacturers are already making small bore cuffed catheters to use
Why do we need more products No one may want to know or believe this but all catheters of the future will be power injectable (end of story) that means all ports, tunneled, acute care catheters, peripheral catheters etc. With the fact that CT and MRI are being used to substitute for invasive testing and are very diagnostic as we go to 128 slice scanners more and more patients will be getting power injectable CT's. Just ask the Phillips manager I rode on a plane with three weeks ago. 128 slice scanner will be the new standard this summer Silicone is difficult to manufacture in very small bore catheters as power injectable at 5 cc/sec or 4 cc/sec. Therefore you will see I believe a new wave of poly users. Is the silicone catheter dead. No, but hospitals will be adding poly alternatives for power injection. The old Hickman type of silicone tunneled catheters will be switching over to small bore poly catheters with small cuffs (easy to dissect out) that are power injectable. Especially in the dialysis patient. The IR doc's are already starting to place these small bore tunneled poly catheters that are power injectable in the jugular but tunneled in the chest or used in the arm as well. As far as infection risk it would be the same as a Hickman and the type of patient we are talking about is the renal patient and the patient who is a very difficult PICC insertion. In other words when a patient is being sent to IR by the high-tech PICC nurse should they spend three hours placing a PICC line or put in a small bore tunneled catheter? If a patient has pulled out their PICC line is it time for another PICC or a small bore tunneled catheter? I guess those are the questions. I agree with Henry Ford, Stanford is using the small bore tunneled poly power injectable catheters. By the way they are well marked as a non-PICC Kathy Kokotis RN Private Consultant Confidentiality Notice: This e-mail and any attachments are intended only for the use of those to whom it is addressed and may contain information that is confidential and prohibited from further disclosure under law. If you have received this e-mail in error, its review, use, retention and/or distribution is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message and any attachments.[v1.0] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway Sent: Wednesday, August 16, 2006 9:20 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: [vascular] RE: tunneled small-bore CVCs I guess I am having a hard time getting to the point where I can accept that we need another type of catheter with a different design. We already have catheters designed for insertion into the jugular and subclavian veins that are being used for long term dwell (e.g., Hohn made of silicone). These, just like any catheter can be tunneled. Are you saying that the OD is too large and a smaller one is needed? Regardless of the material, there is a greater density of skin flora in this area, so the infection risk will always be greater. So this should be one of the last options for long-term use. Is the market large enough to motivate a manufacturer to go through all that is necessary to introduce a new design? I am all for being on the cutting edge of advancement. I have been there all of my 30+ year career. But I can also appreciate what it takes to bring a product to market successfully and but have concerns about adding another layer of complexity. Lynn At 11:40 AM -0400 8/16/06, Nancy Moureau wrote: >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 > <http://www.piccexcellence.com/> www.piccexcellence.com > <mailto:[EMAIL PROTECTED]> [EMAIL PROTECTED] > >-----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 > > >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 > > >[Non-text portions of this message have been removed] > > > >MedComp Proud Sponsor of the Vascular List Serve. >Yahoo! Groups Links > ><*> To visit your group on the web, go to: > http://groups.yahoo.com/group/vascular/ > ><*> To unsubscribe from this group, send an email to: > [EMAIL PROTECTED] > ><*> Your use of Yahoo! Groups is subject to: > http://docs.yahoo.com/info/terms/ > -- 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
