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Gniadek23
CVL advice

Hi, I am looking for some information regarding tunnel lines and the dacron cuff. Has anyone had a patient with an allergy to the dacron cuff? We have a patient who presents like he may have a dacron allergy-swelling and fluid collection around the cuff-aspirated fluid and not infectious. Incidentally treated with steriods for colitis and swelling improved, however once off steriods came back and was larger/tender. His tunneled line prior to this one he developed granulation tissue and the cuff became exposed. He unfortunately needs daily PN so he needs a line. Currently has a PICC line but not a great solution as this is a somewhat temporary line. He is a pediatric patient and will likely need a line for years to come. Anyone have any thoughts on the best type of line to place or any experience with dacron allergy would be helpful...Thanks!

Michelle

lynncrni
 I would contact the

 I would contact the manufacturer of this specific brand and determine the exact components of this specific brand of cuff. There could be different materials used other than dacron. If this is truly and IgE mediated allergy, I would want that to be confirmed by working with an allergist to prove this allergy. Labeling a patient with an allergy to a particular product  could be dangerous to their health. I suspect that there are numerous other exposures to dacron in this patient's environment so you want to be certain the information you provide is confirmed and accurate. 

Was the aspriated fluid cultured so that you can concretely state it was not infected?

How old is this patient? Pediatric covers a very wide range. People with long term use of PN have been known to keep a PICC for extended periods. Also, if the patient prefers, an implanted port could be used, accessed daily, and the patient is totally free of anything during the daytime, assuming cyclic infusion is used. There are patients that are members of the Oley Foundation that have reported using both PICCs and implanted ports for very long PN use. 

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

Gniadek23
Lynn- I appreciate your

Lynn- I appreciate your response. The patient is 6 years old. We have debated a port but question if his reaction to the dacron cuff was an auto immune response as opposed to an allergy would he have the same type reaction to a port. Also the difficulty of a needle stick at least weekly to access the port. He is a very active little boy so I would also worry about needle dislodgement. We are doing ok with a PICC for now but worry about increased risk of line infection with PICC lines as compared to tunneled lines/ports. He also has a true allergy to chlorahexidine and developes a rash with betadine use which makes cleaning the site challenging as well. He is being referred to an auto-immune speacilist so we will wait to see what they have to say. I have reached out to BARD to see about a sample of the dacron for testing, however have not received a response.

lynncrni
 Wow a very challenging

 Wow a very challenging patient. The adult patients with an implanted port for PN access themselves every day, but that might not be appropriate for a 6 year old. I would also not recommend leaving a port accessed for a week in this age patient. I don't think there is much difference in infection rates between a PICC and a tunneled cuffed catheter. Very difficult decisions. 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

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