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Robbin George

Recently found 2 patients out of ICU with introducer/cordis left in place when patient was transferred to 'regular' floor (Also at a recent local INS meeting the subject was brought up)--Probably new nurses unaware that this is a poor practice--What is the standard as applies to these devices outside of the ICU--Are they covered under the standard that states catheter should be removed when it is no longer in use and/or some other standard of practice?

Robbin George

Vascular Access RN Alexandria Hospital Virginia


          At my hospital we have had the statement that "cordis"/ introducer should be removed prior to transfer to med-surg floor.   We are now asked to provide the evidence based literature to support that statement.   The introducer/ cordis is used to place Swan/ganz catheter and S/G is removed when no longer needed but left in place with  usually a triple lumen catheter placed through them until the patient is ready for transfer out of ICU.  Then cordis with CVC is either D/C'd or guidewired to a triple lumen catheter. Good and safe practice does not stand up, need the literature to back it up or we may have patients transferred out of ICUs with the cordis in place. Does any-one have some literature? We would like to keep that statement in our policy. The other question that came up is why is that even mentioned in a central venous catheter policy, since it is not a catheter.   It was placed there because it was used a vechicle to interchange a S/G and CVC with   ease.

Read your instructions for

Read your instructions for use from the manufacturer.  I know the brand that we use states that it not intended for use alone.  That should hold some weight as you are very liable if an event occurs. 


Robin Bell RN B...
The last Intensive Care that

The last Intensive Care that I worked in implemented the policy to remove the cordis secondary to a sentinel event of a patient exsanguinating after transfer to a regular room and the extension pulled off. I believe the year was 1999/2000. Should be able to chase that down as evidence.



I thought the cordis was made of stiffer plastics and considered more thrombogenic than other catheter materials. Catheter materials themselves have been studied to determine which is least likely to contribute to thrombus formation. Perhaps this arguement should be the approach. Our cordis have no clamps on them and this is a safety issue   as well.

Jose Delp RN BSN

Clinical coordinator IV Team

Upper Chesapeake Health

Jose Delp RN BSN

CliClinical Nurse Manager IV Team

Upper Chesapeake Health

One relevant 'standard'

One relevant 'standard' about the introducers is the on about using the smallest size to it the access need. Those IJ introducers are the size of a pencil--way too big for someone who isn't sick enough to be in the unit.


I think you should present

I think you should present the argument of infection rate.

Review Maki's articles as Swans have a high rate of infection vs. the acute care central the lines.  In addition the risk of the air embolism as it is a big tube is higher if disconnection occurs.




Kathy Kokotis

Bard Access Systems

Leigh Ann Bowegeddes
We have a policy

We have a policy discouraging this. Also, in most patients the introducer sheath ("Cordis" is a brand name) is not long enough to reach the SVC, so we have had to educate our nurses and physicians that it is not a central line. We are concerned about the stiffness of it, the shortness, the potential for air embolus, manufacturer's directions for use. Our policy states that this is a peripheral tip termination, and therefore cannot be left in place by itself longer than our PIVs. Policy encourages CVC insertion if central access is needed, and discourages administering any irritants or vesicants via the side port of the sheath introducer, as the exit site for this is not the end of the catheter that is inserted through the sheath, but at the end of the sheath, which may be short of SVC.


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