Re: reverse tapering

[Cheryl Kelley]

There may not be any clinical evidence published yet, but from a facility 
that places 5F and 6F tapered lines, I will tell you that yes, we have seen 
an increase in thrombus in these patients.  I am wondering if decreased 
bleeding at the insertion site is worth the risk that the reverse taper has. 
It only makes sense to question this as with a 6F catheter that tapers to an 
8 or 9F, being placed in the arm, wouldn't that decrease most if not all of 
the blood flow in the vein at the entry site?  This is the area where the 
endothelium is already sensitive due to the insertion process, also consider 
the even larger gauge of the introducer in the vessel, for 5-10 cm and to me 
it is a perfect setup for complications.  Just thinking out  loud!  What do 
you all think?

Cheryl Kelley RN
PICC Nurse and Infusion Consultant
                   and
PICC Nurse at West Virginia University Hospitals
304-823-3196    or     304-669-3061