We've not had the Hohn catheters on our campus until this week. I need to write a policy for care (our interventional radiologist went ahead and started placing them without giving us the option of training in advance. Lovely guy).Â
I'm wondering if there's anything special about caring for these beyond usual central line care but with the extended dwell time. Anything unusual ever happen with removal?
Any tips for us or things I need to include? I have a copy of the manufacturer's IFU, but am looking for anything additional we'd need to know.
Thanks much!!!
Alma Kooistra RN CRNIÂ Â
Alma,
Speaking to the PowerHohn CVC by Bard: the big difference is the VitaCuff Antimicrobial Cuff. The cuff should not be visualized on the outside but should be just inside the exit site, so nurses should be observant of where the cuff is -- if they can see it. The Vitacuff absorbs fluids so expands to twice its original size. The "external antimicrobial collagen matrix" should be absorbed completely in 4-6 weeks; however, this may have the skin grow into/around the cuff and adhere, reminding me of the cuffed, tunneled catheter (Hickman). For this reason, we do not allow our nursing staff to discontinue these lines but have the resident or physician discontinue the line. I got all my info from their web site and our very helpful Bard rep.
Carole
Our interventionalist was adamant that nursing staff can remove these at the bedside. Tomorrow I'm hoping to have time to read the manufacturer's IFU, and I'm wondering if that issue is addressed in their literature.
I also wonder if when the 4-6 wk window has passed and the cuff is absorbed, doesn't this then become a non-tunnelled non-cuffed CVC and wouldn't that make it no better than a subclavian or IJ catheter that was inserted without a cuff?
Alma Kooistra RN, CRNI
I would think that the Vitacuff is supposed to keep the site from getting an infection; but as we know infection can come from other sources. Bard says it can be inserted as tunneled or non-tunneled catheter and is not marked as one or the other but up to the physician doing the insertion. According to Paul Blackburn of Bard: "The Hohn can be removed at the bedside, however, there is potential that the Vitacuff has tissue ingrown into it and may therefore require some dissection for removal." This was from an e-mail Jan 8, 2007. This is why I don't want our nursing staff to discontinue this line.
Carole