In pediatric patients, I find that the most significant difference is the
depth of the vein for reverse tapered catheters. The reverse taper
catheters in adults has the largest part of the catheter in the subq tissue
due to the depth of the vein, not in the vein. With pediatric patients, the
depth is certainly more shallow and allows the largest part to be in the
vein. Am I making sense? Due to this difference, using a reverse taper
catheter might cause the knowledgeable pedi PICC nurse to leave more of the
catheter external. That makes the portion of the catheter with the largest
part of the catheter NOT in the vein, but has enough of the catheter
increased size in the subq to create the tamponade of the tissue to decrease
bleeding.
Since the reverse taper does increase in size and since the depth of
pediatric patients' veins are not as deep as an adult, I think that this is
another step of assessment that challenges the pedi PICC nurses.
Raye, what is your thrombosis rate on the larger catheters from IR? You
mentioned that the larger sizes are unnecessary, but do you have data on
their complication rates to indicate that they are unnecessary? That would
be such good information to prove that they are unnecessary.
We do use 4 fr in many pedi patients, with and without the reverse taper of
the catheter (we have choices of size and reverse taper or not). It depends
on the pedi PICC nurse assessment of the patient whether we use 3 fr or 4
fr.
Gwen Irwin
Austin, Texas
----- Original Message -----
From: "Raye Dillon" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Thursday, October 19, 2006 7:46 PM
Subject: Re: reverse tapering
i agree with you. i work on peds and we almost never use anything larger
than a 3fr if the nurse inserts but when we send kids to IR for
placement (when one of our staff is not available) they come back with
garden hoses 4s 5s and sometimes 6s. that is totally unnecessary.
<[EMAIL PROTECTED]> 10/19/06 9:21 AM >>>
I think we all need to look at why we think bigger is better. These
large 5 and 6 Fr caths are causing more thrombosis. What is wrong with the
4fr
being the norm. unless we need double lumen caths. I am truly concerned
when
I read that there is now a triple lumen PICC. This is especially true in
the
elderly where the veins are smaller.
Raina Pegg RN
