In the 1980's we used a lot of Hohn catheters in patients that went out into
the communty in our leukemia or oncology population. I think we need to
educate our home care colleagues that this is the device of choice with
selected patients for whom a PICC is contraindicated. Removal competencies
will be another issue. If home care is nervous about these removals, then
the patient should return to the outpatient infusion area for removal until
this device becomes more common in the community a group of clinicians
competent with removal are developed.
This is really what is best for this subset of patients.
Nadine Nakazawa
From: DS BROADHURST <[EMAIL PROTECTED]>
To: Nadine Nakazawa <[EMAIL PROTECTED]>,
[EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: RE: PICC and bilat mastectomy
Date: Sat, 30 Sep 2006 21:46:57 -0400 (EDT)
What are your thoughts on sending a patient into the community with a
small-bore line? We don't discharge pt's home with perc. non-tunnelled
lines in the IJ OR SCV. My understanding of one of the rationale is to
prevent hemorrhage in the event of accidental dislodgement? Does the tunnel
sufficiently reduce risk to send these lines into the community? Are they
considered similar to the Hickman/Broviac, only smaller-bore?
Daphne Broadhurst, RN
Ottawa, ON
Nadine Nakazawa <[EMAIL PROTECTED]> wrote:
The risk is lymphedema, which once it begins becomes a chronic and
difficult to treat condition that impacts quality of life. Like Nancy
said, you did the right thing. The patient would benefit from the "small
bore tunneled CVCs" described in recent venous emails, placed in the IJ
with a short tunnel on the upper chest. It can be a Hohn (6 Fr) or a
trimmed PICC (5 Fr). Usually placed by IR.
Nadine Nakazawa, RN, BS, OCN
PICC Program Coordinator
Stanford University Hospital and Clinics
Stanford University Medical Center
---------------------------------
From: "Torres, Martha" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: PICC and bilat mastectomy
Date: Tue, 26 Sep 2006 11:12:13 -0500
Does anyone have any articles regarding not placing a PICC line in a
patient with bilateral mastectomies with lymph node removal on both sides.
Our pulmonologist, who places central lines, felt we sholud have placed one
in a critically ill lady with bilat mastectomies that was getting Levophed
thru a finger IV. He said she was more at risk from the finger IV than she
would have been the PICC, which is true. He had gone ahead and placed a
subclavian line before speaking with me.
Is there any research about this? Is this another thing we do because it
has always been done this way/ I just want to do what is right for the
patient.
Martha Torres RN
Presbyterian Hospital of Dallas
Dallas, Texas 75231
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