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Thu, 08/16/2007 - 17:01

Alma Kooistra

Hohn Removal.......Help!

I hate to sound too desperate, but we have our (very pushy) interventionalist saying that nursing can remove the Hohn catheters at the bedside.......and have hadÂ a couple of responses saying that their nurses are not allowed to remove them at the bedside.Â

Is there a publication that addresses this issue?

I need to get a policy in place asap and I don't know how to proceed.Â I don't want to wait until we have a disaster before I write the appropriate care into policy.Â I also don't want to be sending all of these to IR for removal if that is unnecessary.Â

Is it possible to treat them like PICCs and have the nurses remove unless there is resistance?Â I really prefer not to do it thatÂ way because once the catheter is partially loosened it seemsÂ there would be risk of an air embolus.

I have the manufacturer's IFU and they say nothing about care/removal.Â

I really need to know what the rest of you are doing re removal of these catheters.

PleaseÂ respond......and thanks for your help!

Alma Kooistra RN, CRNIÂ

Thu, 08/16/2007 - 17:28

DML RN

Are the Hohns placed via

Are the Hohns placed via jugular or subclavian?

Thu, 08/16/2007 - 21:16

(Reply to #2) #3

Alma Kooistra

Of the four placed this

Of the four placed this week, three are subclavian and one is IJ.

I know these catheters have been around for a long time, but they're new to us. Personally, I think I'd feel comfortable giving the thing a tug and if it won't budge easily, I'd call IR or some other resource to come and remove it. My main concern is our staff nurses who will be the ones doing removal of these lines if we do it at the bedside. They're accustomed to removing subclavians and IJs, but this line is new to them and I don't want to put them in a potentially difficult situation.

Are the Hohns a commonly used device, and am I crazy to worry about this so much?

Thanks!

Alma Kooistra RN, CRNI

Thu, 08/16/2007 - 21:00

cmnurse

I have removed one Hohn

I have removed one Hohn catheter at the bedside. It was placed in the subclavian and it came out just like a standard triple lumen central line, no resistence, cuff intact. It was fairly simple.

However, I have only seen two Hohn catheters in the past two years so I don't have any more additional info for you other than it did seem like a safe and reasonable nursing task at the time.

Thu, 08/16/2007 - 23:08

cmnurse

As far as I know, we are

As far as I know, we are only using Hohn catheters when a patient is not a candidate for a PICC, and even then a surgically implanted groshong line or a portacath is the next option instead of a Hohn. Just curious, is there a valid reason why your facility has chosen to use these instead of PICCs etc?

Fri, 08/17/2007 - 05:53

(Reply to #5) #6

Alma Kooistra

Yes........our

Yes........our interventionalist has said that they're faster to place.

We do nearly all the PICCs, but when we are unable they go to IR. Our IR dept really hates to do them and this new fella says he doesn't have time to place a PICC. The Hohns go in faster for him. He dictates "This catheter can safely be removed by a nurse at the bedside" in his placement dictation.

When I mentioned safety concerns he said "Just pull it like a PICC". I mentioned having the patient lie down, hold their breath, etc and he said none of that was necessary. He also said that if nursing had any questions about removal they should call him. Can you see why I'm upset?

We need to do something quickly, and my first defense must be a policy. I just need to know whether it is safe to pull at the bedside at all or if we should be sending these pts to IR for removal. That must be written into our policy. I need to know what the others of you are doing.

Thanks!

Alma Kooistra RN, CRNI

Fri, 08/17/2007 - 06:24

Carole Fuseck

Alma, send me your fax

Alma, send me your fax number. I will send a copy of this correspondance to you in case that will help you regarding removal; these are the questions I also asked and were answered by Bard directly via their e-mail. My e-mail is [email protected]. Actually, maybe I'll scan these and send back via e-mail for a cleaner print for you.

Carole

Tue, 08/28/2007 - 00:03

Robbin George

Our IR places BARD Power

Our IR places BARD Power Hohn catheters in patients with restricted access issues who are not PICC candidates--ie nephrology patients and those with peripheral vein obstruction--Many times the catheters are tunneled--Can't recall if we have ever removed a non tunneled version of this catheter at the bedside--But I would certainly use the same technique as with any CVC despite anything the Radiologist said

Robbin George RN VA-BC

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