Hi everyone,
I would like to know your practice regarding accepting an IJ catheter in the home setting and if anyone has resources/articles regarding the risks of having this line at home and the increased infection risk.
Our current practice is we accept these on a case by case basis currently, we have the patient sign a safety contract with the risks of the particular line. I received a phone call today from the head of IR at a local hopital and he was really questioning why and if a tuneled IJ would be better, why we take on certain case by case basis, and if I have anything to support the risks at home particularly dislodgement in an active patient and infection risk.
Any help is greatly appreciated.
Thank you,
Brooke Thompson, RN BSN CRNI
Nurse Manager
Providence Infusion and Pharmacy services
I am not aware of any studies stating the IJ site is a greater risk for infection in home care. The problem with most IJ sites, regardless of where the patient is located, is maintaining dressing integrity. Neck movement can disrupt the dressing. When the puncture site is middle to high neck, this is a risk. But the IJ can be accessed in a low point and the external catheter angled toward the shoulder area. The dressing in this location would not be easily disrupted by neck motion. Dislodgment is a problem with all VADs and requires careful attention to use of an engineered stabilization device, regardless of where the insertion site is located. A subq tunnel is often used for small bore catheters inserted through the IJ site. Right IJ is the straightest path to the SVC so very desireable when renal failure is an issue and PICCs must be avoided. So if the low IJ site is not used, a SC tunnel down to chest area would be appropriate for better dressing management.
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