I run a small vascular access service inserting PICCs and midlines in general medicine/surgery and oncology. I am considering training to include non-tunnelled CVCs, mainly for chemotherapy patients. Becasue I only have the choice of PICCs at the moment my criteria for inclusion is very broad. I want to increase patient choice and fine tune the choice of line to the patient's needs and in response to a risk stratification. I'd be very grateful if those of you offering a multi-line services could share some of your criteria for chosing a PICC over a tunelled CVC and vice versa. I don't want to train to deliver this service only to find that PICCs continue to meet most of my patient's needs and I struggle to maintain my tunnelled CVC competency. Many thanks in advance.
Steve Heath RN
A little unsure of what you are asking because you have referred to both PICC, nontunneled and tunneled CVC. There are clear indications for each but there is overlap. By tunneled, do you mean tunneled cuffed CVAD such as a Hickman®? Or do you mean a short SC tunnel without a cuff? Also are you dealing with inpatient and outpatient? The best resource is the MAGIC Guidelines. This is a ~50 page article published in 2015 and based on consensus. Google MAGIC and you can find the article. there is now also a smartphone app containing these guidelines making it easier to apply them. 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