What we are seeing is non-cuffed catheters being tunneled--a catheter that does not have an antimicrobial or tissue ingrowth cuff.
When I asked IR why, they gave KDOQI as the reason for cannulating the IJ-which I understood.
What I didn't understand was why use a PICC catheter and not a cuffed catheter typically used when tunneling.The answer given was that the patient already had an infection and could vegetate bacteria around a cuff.
The reason is vein preservation, especially avoiding thrombosis in the axillo-subclavian vein in case a dialysis catheter must be inserted later. A PICC or other small catheter is inserted into the IJ. The tunnel brings the exit site out on the chest to avoid the problems with a dressing on the neck. Bard makes several types of tunneled cuffed catheters for this purpose but others are using a PICC for these tunneled but non-cuffed catheters. Yeas ago this practice was tried as an infection control measure but studies did not find that it actually reduce the rates of CRBSI. It will decrease the vein thrombosis though that occurs with an insertion from the arm or directly into the subclavian.
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Vein preservation and lower risk for thrombosis and infection make sense.
I'm concerned that it's a practice that we don't have standards for.
Is it the cuff or being tunneled that makes a long term catheter, a long-term catheter? The physician and discharging nurse may think the patient has a long term tunneled cuffed catheter (this happened).
Also, our policy (based on INS Standards) does not allow a bedside nurse to remove a tunneled line--no distinguishment is made between cuffed or non-cuffed.
I have heard numerous discussions about these very questions and the confusion it causes among staff nurses. There are no recommended optimum dwell times for any CVC, so nothing really defines what is long-term and what is not. You will need some mechanism to determine if the catheter has a cuff and who can remove those with a cuff. A tunneled catheter without a cuff should not be a challenge to remove.