From what Kathy and Nadine have written, my impression is that
they are talking about 2 different things. Nadine wants a small lumen
catheter to be inserted via the jugular veins with a subq tunnel and
no cuff to make it easier to remove. Kathy is talking about a tunneled
and cuffed catheter.
A subq tunnel for a central venous catheter is not new. Here is
what I have from my database:
1.
Andrivet P, Bacquer A, Ngoc C, et al. Lack of clinical benefit
from subcutaneous tunnel insertion of central venous catheters in
immunocompromised patients. Clinical Infectious Diseases.
1994;18:199-206.
2. Trerotola S, Kuhn-Fulton J, Johnson M,
Shah H, Ambrosius W, Kneebone P. Tunneled infusion catheters;
Increased incidence of symptomatic venous thrombosis after subclavian
versus internal jugular venous access. Radiology.
2000;217:89-93.
2.
I know there are more articles on the subq tunnel, but can not
find them quickly. Lynn
At 5:58 PM -0600 8/16/06, Kokotis, Kathy wrote:
The new small bore tunneled catheter I am thinking of (power line) is not a PICC. Manufacturer indications are for tunnel placement in subclavian, jugular and I think the arm veins are listed but do not quote me. It is mostly being placed in the jugular (internal) but the catheter comes out of the chest. the Hohn does not have a cuff and these small bore lines do have a cuff. These lines are also made of polyurethane to allow for power injection of up to 5 cc/sec. Hohn, Hickman, Groshong, Vaxcel, Leonard and all the other tunneled lines I forgot the names of are not approved for power injection. This is a new line I am definitely seeing in the renal population and the physicians are paid a tunneled insertion fee and a removal fee.
Let's face it the IR docs are getting the worst of the worst and are these PICC candidates or tunneled candidates. How many hours should they put in to place a PICC line in one of these difficult patients?
Is a EJ/IJ a central or peripheral. Here is how I define that one. If the tip of the catheter terminates in the SVC it is central. If the catheter length remains in the neck it is peripheral. However it is a large bore vessel with complications that should be respected for arterial puncture, air embolis, etc. It carries a higher risk of access versus a small peripheral vessel.
soap box over
kathy
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From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway
Sent: Wednesday, August 16, 2006 7:33 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, 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
