RE: reverse tapering

[Kokotis, Kathy]

I played with the reverse taper today

To get to the zero mark which lies outside the skin it is 2 CM and that is the 8French portion

the 7 French portion is another 4 cm of which 2 cm are usually subQ

there is very little of the larger taper in the vein

 

Roger thanks for this input.  I can see the 50% as a guideline

 

I will tell everyone a fact I have learned from reading almost every study on thrombosis in the last five years.  If a patient is going to be symptomatic it usually occurs in the first two weeks of dwell.  The key word was symptomatic.  This is not the case with a subclavian as it has to go thru layers to show symptoms.

 

If Kearns and Grove are right nutritional support and chemotherapy have a way higher rate.  Three times the rate of antibiotics.  Their sample size on 6 French was way too small to see how much of a difference it made versus a 5 French. 

 

To me in an adult hospitalized patient getting blood draws and maybe I am wrong but a 3 French is useless.

 

Kathy

 

 

 

Confidentiality Notice:  This e-mail and any attachments are intended only for the use of those to whom it is addressed and may contain information that is confidential and prohibited from further disclosure under law. If you have received this e-mail in error, its review, use, retention and/or distribution is strictly prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message and any attachments.[v1.0]

---

From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Roger Soriano
Sent: Friday, October 20, 2006 12:10 AM
To: Earhart, Ann
Cc: Cheryl Kelley; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: reverse tapering

From what I was told(which made sense afterward),  DVT happens when your catheter occludes 50% or more of the total internal lumen WITHOUT THE TOURNIQUET!!!  Also, try to get to know your catheter... that 7Fr at the hub is not whats occluding your vein.  If your vein is 2cm deep, the catheter may be down to 6Fr at that point.

Here's a French/CM conversion for you. I hope it helps:

3Fr = 1.0cm
4Fr = 1.35cm
5Fr = 1.67cm
6Fr = 2.0cm
7Fr = 2.3cm
8Fr = 2.7cm
9Fr = 3.0cm

I have been more conservative and resolved to using up only 1/3 or 33% of the undisturbed vein, meaning without the tourniquet because this is at what state you are going to leave your PICCline in, not expanded with a tourniquet.  When I resolved to using this formula, I have significantly reduced my DVT rates.  Haven't completely eliminated it, but significantly reduced it.  Some pts are just hypercoaguable that you just can't predict who will do it and who won't.  From what I understand, Oncology pts are more susceptible to this than other populations in the hospital.

I personally don't use any reverse tapered PICC simply because of my facility prefers another brand which is non-tapered.  Nothing to do with the taper, but the same rules should apply to those which have reverse tapers as well.

Sorry for rambling...


--
Roger Soriano, RN
Vascular Access Specialists
818-687-8348

CONFIDENTIALITY NOTICE:
This e-mail message, including all attachments,
is for the sole use of the intended recipient(s) and
may contain confidential and privileged information.
If you are not the intended recipient, you may NOT
use, disclose, copy or disseminate this information.
Please contact the sender by reply e-mail
immediately and destroy all copies of the
original message including all attachments.
Your cooperation is greatly appreciated.

On 10/19/06, Earhart, Ann <[EMAIL PROTECTED]> wrote:

So what evidence is everyone using to decide if the vein is "large enough" to support a 5 or 6 french catheter, or a tapered catheter? What parameters are everyone following, or have you developed to determine "appropriate vein size"?

Yes, we have our parameters, but wanted to provoke some thought and interesting conversation to see how everyone has determined their practice/guidelines and if you have written them into your policies/guidelines.

 

Ann Earhart, MSN, CRNI

Clinical Nurse Specialist-Adult

Vascular Access/PICC Team

Banner Desert Medical Center

Mesa, Arizona  85213

office-480-512-3980

pager-602-420-3240

e-mail:  [EMAIL PROTECTED]

 

---

From: [EMAIL PROTECTED] [mailto: [EMAIL PROTECTED]] On Behalf Of Cheryl Kelley
Sent: Thursday, October 19, 2006 8:16 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: reverse tapering

 

All veins should be assessed in depth when placing large lumen lines, such as the 6F triple or the tapered lines.  We measure the vessel and then decide if it is large enough to accommodate the catheter.  There are some patient's who simply do not qualify for a triple simply because the vein is not large enough.  Of those who qualify, the measurement that we take is to see if the vein can accommodate the 6F catheter.  I guess we should also be looking at how large the vein is at the insertion site, where the catheter is tapered to an 8 or 9F.  Isn't the whole concept of decreasing thrombus allowing blood to continue to flow inside the vessel?

 

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