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Mon, 08/20/2007 - 15:20

tamimendonca

IR trimming the end of a Groshong, creating an open-ended

What are your views on an IR doctor trimming the end of a Groshongs, creating an open ended central line? He did this because he needed to insert a stiffer guide wire into the cath in order toÂ directÂ to the SVC. IÂ was uncomfortable but "outnumbered"Â Your thoughts?

Mon, 08/20/2007 - 17:26

lynncrni

An expensive method for

An expensive method for inserting a PICC, but I guess that depends upon how much your facility pays for the Groshong. Also, I don't think cutting any catheter is a good idea but we do not live in a one-size-fits all world. Things like this are within the judgment of the inserter and this decision should be based on a risk-benefit assessment. I don't understand why cutting the Groshong valve off would allow for a stiffer wire. The wire that comes with the Groshong could have been removed and the other wire inserted from the external end without cutting the valved end. Does sound very strange to me. 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

Mon, 08/20/2007 - 19:06

momdogz

Mari Cordes, BS RN Nurse

Mari Cordes, BS RN

Nurse Educator IV Therapy

Fletcher Allen Health Care

Just leaving the discussion I 'started' about trimming Power PICCs! (which are meant to be trimmed) - this one really sounds alarming. The Groshong engineering is primarily about the tip (and the silastic). I don't understand, either, why cutting the tip off would allow the stiffer IR type guidewires to pass into the catheter more easily. Our IR docs place BARD groshongs, and reposition our (very few!) malpositions, and never have a reason to cut off a Groshong tip.

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Mon, 08/20/2007 - 22:53

(Reply to #3) #4

tamimendonca

It was indeed unusual. The

It was indeed unusual. The groshong was up against a valve in the brachial vein and would not advance. Under fluoro the IR spotted a branching vein (distal to the problem valve) going from that brachial to a "paired brachial". So he trimmed the end of the groshong, inserted the guide wire, bent the end of the wire, then guided it into the "paired brachial" via the connecting vein. He then ran the guide wire into the SVC, following it with the catheter!

Tue, 08/21/2007 - 10:11

(Reply to #4) #5

lynncrni

OK, now I understand. The

OK, now I understand. The issue was the maneuverability of the catheter. With the closed internal tip and the valve, he could not get the guidewire to extend beyond the catheter tip so that he could manipulate the catheter in the desired direction. This sounds like a very unusual case. Lynn