There is a procedure involving a short subq tunnel. This procedure
may or may not use a catheter that has a subq cuff. The presence of
the ingrown cuff should be the primary reason for nurses not removing
it. A short tunnel alone should not prohibit removal by nurses with a
documented competency. This is not the same type of tunneled, cuffed
catheter such as a Hickman. Lynn
At 8:35 PM -0500 10/2/06, Alma Kooistra wrote:
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.
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
