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Deb Gnegy
Policy request-damaged catheters

Does anyone have a policy for removal or repair of damaged catheters?

I'm specifically looking for time frame---to set up guidelines for handling situations such as: a multi-lumen line with one cracked hub on a Friday evening.

How long do you allow the line to stay in place with the damaged lumen clamped and "taped"?

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

There is no published magic time element.  It should be fixed immediately if possible especially in case of subclavian or jugular due to risk of air embolim or bleed out.  Especially air embolism regardless if clamped.   

Kathy

Kathy Kokotis

Bard Access Systems

lynncrni
Catheter repair can only be

Catheter repair can only be done with a repair kit made for the specific brand of catheter being used. Do not use Brand X repair kit with Brand Y catheter as the exact specs will not be the same and you could risk catheter embolism. Repair vs removal and reinsertion is a decision that must be based on a careful risk vs benefit analysis. All damaged catheters must either be repaired or replaced ASAP to reduce the risk of air embolism and CRBSI.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Deb Gnegy
  To clarify the

 

To clarify the situation:

Our PICCs are inserted in I.R.  We do not have a bedside insertion team.  IV Nursing team requested that a dual lumen PICC with one port damaged (a cracked hub-known to occur with this brand) be replaced on a Friday evening.  The initial solution was to make-do with the available port until I.R.'s next business day.  The obvious patient safety issues were pointed out and the line was changed that evening.  The question that remained was, can we define an allowable time frame for replacing a multilumen catheter when working ports are still available?

Deb

Deb

lynncrni
I have never seen any

I have never seen any publication or organization take on this issue. Sooner is always better for obvious reasons. This is another reason for an vascular access/infusion therapy full service team, 24/7.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Deb Gnegy
Lynn, Our I.R. folks are

Lynn,

Our I.R. folks are insisting on info supporting removal of the catheter ASAP, against their argument that if a catheter is multilumen, with only one port damaged, there's very little risk to the patient if the port is left clamped and unused until it can be replaced (on their next business day). 

Seems to me that even if air and bacteria are unable to breach the clamp, it's still a medium for thrombus and bacteria--just sitting there unflushed.  There is a reason we flush lines.

I believe they may have the same arguement with a multilumen that has one port occluded (rather than damaged).  They've been known to "power" flush a line with a 3 cc syringe. 

Do you know of any publications that address the multilumen factor.  It seems that's the foundation for their argument.

I think we're going to need IC support on this. 

Deb

Deb

lynncrni
I am sorry but no

I am sorry but no publications of any kind come to mind quickly on this issue. Others may know of some but I can't think of any. I may not be thinking so well though because I am jet lagged from traveling to China and still have 3 more days to go before returning home.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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