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
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