Recently the healthsystem where I work has taken away the catheter exchange procedure related to two primary rationals. We have two facilities, one has done catheter exchange and one that has not related to the intial training of the clinicians. The first being that there is no research that shows that nurses should be doing over the wire catheter exchanges unless it is under fluoroscopy with advanced degrees along with the manufacture has no formal recommendations about catheter exchange and the second is a concern about embolizing a thrombus using the wire.
I did notice that the INS standard does not mention over the wire or through the cannula exchange. However catheter exchange is still a standard of care. The CDC says over the wire is appropriate, but makes no reference to nurses. I have surveyed the 5 neighboring hospitals and all are doing over the wire catheter exchange even without a policy. We have written a policy but the debate is whether to use only through the cannula.
I do not understand why we would need to use fluoroscopy during this procedure when we use the same wire to do the PICC insertion and do not pass the axcillary and as far as embolizing a thrombus, if the thrombus is present the risk for embolism is the same when the catheter is d/ced as compared to an exchange.
There is one more area of debate. There has been issue regarding the initial training of the clinicians who do catheter exchanges and competency. My team leader has been performing catheter exchange for 15 years. Her initial training included catheter exchange. She has a certificate of completion for the class, but no formal check off for catheter exchange from the class. I was checked off by another employer prior to coming to my current job. I do have a check off in my file from my team leader. How do we show competency to the state surveyer? There has also been a question of whether my team leader (who has been doing catheter exchanges for 15 years) and myself (who has been doing catheter exchanges for 3 years) and both of us have the CRNI and VA-BC certifications, are qualified to teach the catheter exchange.
One more question...What are the qualifications of a clinician to teach a hospital based picc insertion class? My team leader has written a class for our new employees and has come under some scutiny.