I'm interested in some feedback on how well the guillotine cutting device is doing? I think Arrow stocks it in their kits. What are the pro's and con's? Does anyone know of any research articles on the guillotine device? I just know that using the scissors provided in our kits makes a very jagged, uneven slice. There has to be something better out there!
Thank you,
Ann - Midland, MI
There is published evidence that scissors are the worst device for cutting a PICC. There was some internal studies years ago when Ron Luther from Luther Medical created the guillotine device for this purpose, although I don't think they were ever published in a journal. BD acquired Luther Medical many years ago so they may hae these internal studies. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
first off follow manufacturer recommendations for trimming and what they suggest to use or whether trimming is even acceptable. I believe that is what INS 2011 Standards suggest. the manufacturer is the number one opinion.
Most devices are timmed including ports, tunneled catheters, PICC's. One size does not fit all.
Second the only published study to date is done by Janet Pettit in JVAD on trimming and her final results demonstrate that there is no link between increased thrombosis and trimming with any device. Janet's work looked at various trimming devices. There were also no adverse events reported such as vessel perforation in regards to trimming in her study
kathy
Kathy, the manufacturers instructions for use is certainly a very important resource. And yes, most catheters are trimmed at insertion. I would hasten to add though that the manufacturers only have studies, usually bench study or in vitro studies on their device and cutting. No one has published any actual clinical outcomes with cutting the catheter as the isolated variable for any type of catheter. It has been a while since I read Janet's study but I also think hers was a bench study, not a clinical study in patients. So I think your statement about no adverse events is a little misleading. We simply do not have a complete answer to this question yet. And it is important to note that according to the Infusion Nursing Standards of Practice, manufacturers instructions for use is a level 5, the lowest form of evidence on the scale. We definitely need clinical outcome data on this issue. Janet article did identify jagged edges and very small fragments associated with PICCs that had been trimmed. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I think it is safe to say there have been at least a million PICCs placed using each method, sissor cutting, scalpel cutting, and guillotine cutting and the most data anyone has produced were photographs that show definite differences in the look of the cut edge. Until someone shows some outcome differences attributable to the catheter's tip edge, this is a distinction without a difference. There have been enough catheters placed using each method so that if there was anything definitive enough to find, it would have been found. Certainly the manufacturers who market these different cutting devices would find a way to get some evidence, if it was anything but a marketing distinction. Until they do, it is just a variable that is controllable but not very significant.
Daniel Juckette RN, CCRN, VA-BC
My major concern is the impact of jagged edges from cut catheters on the incidence of vein thrombosis. We know that it can be high with PICCs and jagged edges could produce thrombosis. This has never been studied so I don't think we can rely on the high number of PICCs and the manufacturers bench studies. That would be the same as a hospital saying they don't have any CRBSI or name any complication, but they have never done any data collection to measure the specific complication in question. I have always been concerned about cutting catheters and my concerns are still present since there has never been any clinical studies in real patients. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
The only study done on patients to date on trimming and complications is by Janet Petit JVAD who looked at 116 PICC lines of which 101 were trimmed
No thrombosis noted with trimmed catheters. Phlebitis rate lower with trimmed catheters
I have attached the reivew of the INS citations to the trimming recommendation. None of the citations are prospective, radomized and only part of the petit study was blinded
Trimming of PICC Lines: Review of the Evidence Based Literature
Author
Publication
Year
Prospective Study
Randomized Study
Blinded Study
Results
Comments
Petit
JVAD
2006
No
No
No
Phlebitis rates
0.2% Trimmed
0.7% Not trimmed
No thrombosis noted
No link to thrombosis established with trimming of a PICC
101 PICC’s
111 Trimmed
15 Not Trimmed
Retrospective study
Petit
JVAD
2006
No
No
yes
No link to thrombosis established with trimming of a PICC
48 Trimmed PICC’s
Evaluated under digital photography and microscopy
Bench study
Ruttledge
Journal of Clinical Innovations
2006
No
No
No
No link to thrombosis established with trimming of a PICC
Review of the literature on PICC lines
Suggested trimming to follow manufacturer guidelines
Scalpel and sharp scissors
Trotter
Neonatal Network
2004
No
No
No
No link to thrombosis established with trimming of a PICC
Microscopy bench study of trimmed catheters
Pauvez
Thrombosis
Research
2004
No
No
No
No link to thrombosis established with trimming of a PICC
5 PICC’s trimmed and evaluated under microscopy