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anna liang
Powerline migrating out

Hi all, we have 3 powerline mightating out with cuff exposed the last two months. it is frustrating to parents/patients/staffs/surgeons.

Please share your recommendations/ success story.

lynncrni
By Powerline, I think you are

By Powerline, I think you are referring to a specific brand name. This would be dislodgment of the CVAD, which means the tip location has changed. That is the most critical issue. You would need to know what is being infused through it, how much deviation there is from the original tip location, if the original was correctly positioned at CAJ, and the anticipated length of time remaining to need the line. I would invesstigate why these are becoming dislodged and what practice changes are necessary to stop this from happening. 

 

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

mary777
You need to investigate how

You need to investigate how and why they migrated out so the cuff was visible. Some of our interventionalist will suture the line in right at the catheter skin junction so the power line can not move at all and this give the cuff a chance to adhere properly while other will suture them further down on the line leaving several cms externally visible. When they leave several cms visible and it is sutured past this it can allow it to get pulled out so there is a big loop between the catheter skin junction and where they sutured it.  Once the cuff is seated we do remove the sutures. What we discovered it is that we must check every tunnelled power line the day after it is placed and make sure the line dressing is very secure. You must also assess how the nurse is attaching IV fluids and where they place the pump. They must not allow too much tension to be placed on the power line and make sure the IV line as some slack. These are simple things but I see too many nurses not taking these simple precautions to protect the tunnelled CVAD. Once you determine why this occuring you can then properly address a solution. You can't always request how each interventionalist will practice but you can do many things once you can forsee a problem and then take steps to prevent it.    

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