This week I found a patient with a 'Power Line' in place. This is a patient who had an inappropriate request for PICC placement and was sent to interventional radiology for a Hohn. It was time for discharge to a swing bed so I took a look at her 'Hohn' and found out what she had was something different.
According to the interventionalist we've had the Power Line in-house for a long time, but somehow that has escaped me.
I have the package insert and it helped me a lot (I need to write a policy for care and removal) but I can't find anything about dwell time. The rad says it can stay in indefinitely (as long as it's needed, anyhow) just the same as any tunneled catheter. I'd like to have more than just the word of the interventionalist on this but I can't find it on the insert.
I'm also somewhat skeptical about sending these patients out of the house with the line in place when it is likely there's nobody on the other end (small hospital) who is familiar with the removal process. The rad says, 'They come out easy just like any other central line' but that isn't reflected in the package insert where it discusses the possiblity that the cuff may enmesh in the sub-q tissue and require dissection. Since we send patients to facilities where often there is no surgeon....perhaps nothing more than a mid-level nurse or PA.......I'm a little uncomfortable with turning these patients loose with a Power line in place.
So my questions are...... What is the dwell time on the Power Line, and have you ever required assistance when you removed one of these?
Thanks!
Alma Kooistra CRNI
There is no cuff on a Bard power PICC. Our hospital has been placing them for around 4 years and I have never had a problem pulling one following the INS Standards of Pracice. Kathy k or Lynn might have more info though. Maybe I go over boared, but I do sterile site care with mask and use sterile gauze to hold pressure at the insertion site when removing, then cover with a sterile gauze with petrolium and cover that with a tegaderm. I undersatand what you are saying about not being sure if others out there are aware of proper removal technique because I have had pts tell me the nurse in the MD office just pulled it out and covered it with a bandaid! Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
Valorie you are correct that there is no cuff on a Power PICC but the question referred to a Power Line. Power Lines do indeed have a tissue ingrowth cuff and may require some surgical intervention for removal. They are long term small bore central lines and the dwell time is the same as any other long term device. As long as it is functioning and not infected it can stay in! Power Hohns also have a cuff but it is a antimicrobial silver based cuff not a tissue ingrowth cuff. The brand new nursing trays for jugular insertion by nurses do not have cuffs on the Power Hohns. Speaking to the original concerns, I believe the type of catheter that a patient needs should be determined by the patients needs and not if a facility has the right personal to remove it. A PowerLine is ideal for a mastectomy or renal patients just like a implanted port is often ideal for CA patients. I hope this helps!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
Stephen is correct - PowerPICC and Power Line are not the same catheter. Also, there is never any actual dwell time information in the instructions for use from a manufacturer. Catheters come to market as either less than 30 days or more than 30 days, which are determined by the characteristics of the device. Dwell time is a clinical decision based on patient needs, established standards and guidelines from research. Optimum dwell time of any catheter is unknown. 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
Power line is cuffed. It is market approved for long term dwell (>30 days with no end date).
Additional information and instructions for removal may be obtained on Bard Access Systems Clinical Support line at 901-595-0700 and press clinical support
Kathy Kokotis
Bard Access Systmes
I meant 801-595-0700 for the clinical support at Bard Access Systems