Forum topic

24 posts / 0 new
Last post
philiprn001
catheter vs vein size

 

All,

After a fairly extensive search, I remain unable to find a reference on criteria describing catheter size as it relates to vein size. Does anyone know where I may find such a reference? If so, I would really appreciate if you could pass it on. Inclusive of peds would also help.

 

Thank you very much.

Julie May
vein and cannulas size

Philip,

The two references I have here at work that mention vein and cannula sizes are:

Alexander, M., Corrigan, A. Core Curriculum for Infusion Nursing 3rd edition, p. 37 4. b,  Lippincott williams & Wilkens 2004

&

Hankins, J.,   Hedrick, C., Lonsway, R., Perdue, M. Infusion Therapy in Clinical Practice, 2001 p. 380, W.B. Saunders Company

My INS standards of care are at my home but i am sure i remember that the new 2006 standards also call for the smallest gauge cannula in the largest vein that will accomadate the prescribed therapy (not including anticubitals as they are saved for emergencies and PICCs and blood drwas if possible).

Hope this helps,

Have a good day,

Julie May, RN, BSN, CRNI

Lancaster Regional Medical Center

Nursing Education

philiprn001
Julie, Thank yoiu very much.

Julie,

Thank yoiu very much. I appreciate your time.

Phil

Julie
Your welcome Phil.
Your welcome Phil.
lynncrni
I don't think you will find
I don't think you will find a specific article that recommends a specific amount of space to be left inside the vessel after any catheter is placed. The INS standards have always stated that smaller catheters in larger veins are better. But think about it - we have not had the technology to measure vein diameter until now. So I am not aware of any studies that have actually put any numbers to this. I think it is fair to say that we should stay with the smaller is better approach. But we just do not have studies yet with specific vein measurements. I do like Cheryl Kelley's approach to maintain at least 50% of the veins lumen size after cannulation. Great idea, just needs to be validated by published research. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

philiprn001
Thank you very much, Lynn. I
Thank you very much, Lynn. I appreciate your time. -Phil
estevens102206
Is anyone out there very

Is anyone out there very familiar with the Grove study that discusses thrombus rates and PICC French size? This study seems to have been done before all of these large tapered PICC lines like the Bard and MedComp came into the market so I was curious if anyone is seeing an increase in DVT's and phlebitis rates. There seems to be a growing call for these large triple lumen PICCs for the ICU/CCU patients but I wonder if we are looking "long term" enough for vessel preservation of these patients.

 

Eric

Eric

Timothy Royer B...
We have been using the

We have been using the larger PICCs (6fr) including those that are tapered.  We have not seen a change in our thrombus rate and our rate was low to begin with.  Will have to admit though that maybe 50% of the time the PICC is precut too long and not all of the taper is in. 

I do have a copy of the Grove file which I will try and attach.

kokotis
first there is no

first there is no publication that compares vein size to catheter size

Second the Grove study is worthless !!!

I need to publish this

The Grove study was conducted in 1997 with silicone catheters only.  I am not sure the reverse taper existed in silicone in 97 unless Cook had it.  The radiologists used the Cook silicone in the study and the nurses used Groshong silicone with no reverse taper.  The rad's put in 50% of the PICC lines and the RN's 50%.  The rads used upper arm, micro, and ultrasound.  The RN's used the break-away sheath in lower arm veins.  The RN's had a 10% thrombosis rate for the 5 french PICC line versus the rads 5.5%.  Could location and not using high tech technique account for this.  Yes.  Upper arm placement did lower the rate of thrombosis.  Therapy was the main factor however on thrombosis occurrence and not size of the catheter.  antibiotics led to a 1.6% rate of thrombosis accross all categories of french size versus chemo at over 8% and TPN at almost 5%.  If I were to make a conclusion based on Grove the following would apply:

 

Upper arm placement with ultraound and micro is mandatory to lower thrombosis

Patient therapy should be assessed in choosing the french size if possible. 

If the patient is receving chemotherapy use a port not a PICC as the rate of thrombosis is higher than the acceptable range in the SIR benchnmark of 6%

If the patient is getting nutritional support I have no idea on helping you out as they are the ones needing a triple lumen 6 french.  I would say make sure the tip is in the right place as the tip position in the grove study did effect thrombosis rate.

As far as french size went in the grove study one would actually have to pull out the data by therapy type and catheter size to determine the real results.

If I am not mistaken the 6 french PICC lines used in the Grove study were single lumen 6 french as the triple did not exist in 97 and the 6 french single lumen manufactured by Cook medical was used for oncology patients primarily.  The rate on the single lumen 6 french in oncology patients was 10% in the Grove study.  Since chemo had an overall rate of 8.3% I am not sure if it was the chemo or the size of the catheter or the cancer.  What is your reasoning.

Always pull apart a study and never take it for face value.  It may not say what you think it says 

 

 

 

Kathy Kokotis

Bard Access Systems

estevens102206
I am not sure you are

I am not sure you are qualified to call someone's study "worthless." Seems to me that the main summary of the Grove study is that you should use the smallest possible French size catheter whenever possible. If you can use a 5 French PICC line that does not taper up two French sizes and still achieve the therapy you desire, then that is better for the patient. 

 I would like to get some other opinions instead of a manufacturer's rep that is trying to justify or push their product. Thanks.

 

Eric

Eric

T Hufcut
Does anyone have any
Does anyone have any articles newer than the Grove study from 1997?  I am working on putting together information for my facility with the national threshold.  I would appreciate any help. Thufcut

Tammy Hufcut, RN

PICC Nurse

St. Lukes/Cornwall Hospital

Newburgh, NY

kokotis
There is a national

There is a national benchmark on thrombosis and PICC lines published in 2004 by the Socieity of interentional radiology at 6%

e-mail me privately and I will attach

[email protected]

Kathy Kokotis

Bard Access Systems

Shirley Bezditny
hi could anyone tell me what
hi could anyone tell me what is the smallest gauge needle one may  use for blood administration (adult)?
barbannhewitt
At our institution blood can

At our institution blood can be administered through a 22 gauge catheter if an infusion pump is used. 

Barbara A. Hewitt, RN CRNI

IV Clinical Educator

Dartmouth Hitchcock Medical Center

Barbara A. Hewitt, RN CRNI

IV Clinical Educator

Dartmouth Hitchcock Medical Center

emily
remains unresolved still

I came across this post while googling about the recommendation re PICC catheter size vs vein size. It has been 7 years since this was originally posted and I still couldn't find any published articles for recommendation. Do any of you have some information about it or what is the guideline you are following in your facility?

lynncrni
Julie is correct that these

Julie is correct that these statements are now and have always been in the INS resources. But ultrasound is now allowing us to measure the vein lumen size and choose a specific catheter diameter that will fill no more than a certain percentage of the vein lumen. That is the clinical study that I have not found yet. This is the only study I know of.
1. Nifong TP, McDevitt TJ. The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters. Chest. Jul 2011;140(1):48-53.

Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

admin
Article

I'm unable at this time to add new content (part of the update gliches), but below is the url to NCBI's abstract of the article Lynn mentions:
http://www.ncbi.nlm.nih.gov/pubmed/21349931

Kevin Arnold, MSN, BBA, BS, BSN, RN
Web Manager, www.iv-therapy.net

emily
Thanks to Lynn and Sarah

Thanks to Lynn and Sarah on the article! I hope we can come up with the recommendation on the actual number on what is the the lowest catheter vein size ratio for PICC placement to guide us clinically. We sometimes have to place pedi PICCs on neonatal patients. Our success rate on the neonatal population is very high but none of them should be a candidate based on the size of the vein since the 3Fr catheter takes up the whole vessel space especially with the reverse taper. I am having a very hard time explaining to the doctors that pedi PICC we are doing should be their last resort after they have considered everything else. I am not getting any where. I have babies occluded bilaterally at age of 6 months from PICC lines. I have doctors swear to me that the baby is NOT going to need any other PICC lines in his/her life since he/she will be completely healthy...... I don't feel so good about what I have do to the new borns.

mrdo2
Vein to Catheter Ratio

Hi All, Hope this is helpful to your discussion.
I found the following article by Sharp, R, Cummings, M., Fielder, A., Mikocka_Walus, A., Greech, C. and Esterman, A. Which I believe was published in mid January titled, "Catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): A prospective cohort study." International Journal of Nursing Studies. December 19th. The conclusion "found that a 45% catheter to vein ratio was the optimal cur off with high sensitivity and specificity to reduce the risk of VTE."

admin
here's the article

Kevin Arnold, MSN, BBA, BS, BSN, RN
Web Manager, www.iv-therapy.net

emily
This is what I was looking for.

Hi Sarah, thanks for your effort! This is exactly what I was looking for. I hope we can have some kind of catheter vein ratio in the guidelines soon.

Chris Cavanaugh
There is this reference from 2011

Chest. 2011 Jul;140(1):48-53. doi: 10.1378/chest.10-2637. Epub 2011 Feb 24.
The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters.
Nifong TP1, McDevitt TJ.

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

kejeemdnd
I am so reluctant to make

I am so reluctant to make practice recommendations based on these sorts of in vitro studies. There are so many variables present inside the human body that can impact the movement of fluid inside a plastic catheter. It's this sort of "evidence" that has us using "pulsatile," "vigorous," "push-pause," and "push-pull" flushing techniques.

Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA

emily
Thank you for your help as well!

Thank you Chris! I appreciate your effort as well!

Log in or register to post comments