I'd love some feedback & some opinions please.
Two questions... first, do you make a cut before inserting your introducer over the wire?Â Would it increase the risk of infection by making a cut in your opinion?Â I'm thinking the moisture from bloody or serous drainage can be prevented by placing the line through a puncture site rather than through a small cut.Â Everything I rationalize about this tells me that it has to be better to avoid a cut.Â I'd love to hear some opinions...
Next question, whose introducer do you use & what's your opinion of its ease of insertion... especially without a cut?Â
I have opinions of my own but would prefer to hear what others are thinking & experiencing before I share mine.Â Â
Some history:Â We've been using the same picc kit manufacturer for many, many years.Â We started with their kit back when all we had was the Excalibur introducer (AC insertionÂ w/o ultrasound).Â When ultrasound came along... we were making the cut & placing a pressure dressing.Â There were some that bleeding was still a BIG problem &, I think this was when we started drawing a line at INR & PLT's.Â We were also having issues with catheter kinking in the tissues between skinÂ & vein.Â This was what brought about the reverse taper... it was intended to reinforce the tunneled portion of the catheter & reduce theÂ occurrence of kinking.Â A beneficial side affect was noticed... it acted as a tamponade of the site.Â We found that with a cut...many would stillÂ ooze & bleed.Â We started inserting the introducers w/o a cut... wow, what a difference!!!Â Â We completely eliminated the gauze pressure dressing & rarely (very rarely) ever had oozing of any kind.Â Â This also changed the way we handled orders for pt's in need of a line but with high INR or low PLT's.Â The company we've been with has changed their introducer toÂ one that can not be inserted w/o a cut the majority of the time.Â Â We first insert the dilator w/o difficulty, reassemble with the introducer & it will not go... ifÂ it does go, it feels like it's causing much unnecessary trauma as it passes.
Thanks in advance for your input... I'm finding this very frustrating.Â I feel likeÂ our currentÂ manufacture is forcingÂ us to either stay with them & take a giant step backward in the way we practice or, start shopping for better equipment.