Our bedside nurses (and home care nurses) remove lines all the time, but I
don't believe they're pulling tunneled catheters. Thought that was a
procedure that required someone with more specialized training to do.......
Alma Kooistra RN, CRNI
----Original Message Follows----
From: "Lynn Hadaway" <[EMAIL PROTECTED]>
To: "DS BROADHURST" <[EMAIL PROTECTED]>, "Nadine Nakazawa"
<[EMAIL PROTECTED]>, [EMAIL PROTECTED],
[EMAIL PROTECTED]
Subject: RE: PICC and bilat mastectomy
Date: Mon, 2 Oct 2006 10:40:16 -0400
Based on a conversation with nurses in a class last week, I would say that
the tunnel does not reduce the risk of bleeding after removal as they
described several situations where these tunneled catheters were removed and
the nurse failed to hold pressure on the appropriate spot and bleeding did
occur. This would require a documented competency to understand the tunnel,
its purpose, and how to properly remove it. Pressure is required on the vein
entry site, not the skin exit site. If there is a subq cuff, there could be
other challenges with bedside removal by nurses. Lynn
At 9:46 PM -0400 9/30/06, DS BROADHURST wrote:
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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Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
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http://www.hadawayassociates.com
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