At my organization nursing does not pull tunneled lines and it says this in our policy. I heard that IR has used PICCs and tunneled them. The debate here is whether the tract denotes tunneling or cuff . If so should we then call it a tracted PICC line indicating it is a non-cuffed tunneled line and can be pulled by nursing (education would be required of course) ? I am also not sure if IR really used a Powerline and everyone called it a PICC. It was IJ placed so it could be a true PICC. Does anyone use any special terminology to distinguish these other than tunneled PICC? Nurses here only know they can't take out tunneled lines and the Powerline looks alot like our Power PICC. Also does anyone know the rationale for tunneling the PICC versus just placing a a non-tunneled CVC or using a cuffed CVC at the IJ?
Thanks
Tahitia
There are 2 reasons for tunneling a catheter. 1) to move the skin exit site away from the vein entry site in the hope that this will reduce the extraluminal risk of infection, and 2) to move the skin exit site out of the neck and away from this area of movement and difficulty with maintaining the dressing. For the first reason, this does work if the tunnel is long enough, however tunnels do become infected and the rates of BSI from tunneled cuffed catheters is about the same as with percutaneous CVCs.
The second reason is used primarily for insertion of a small catheter like a PICC into the IJ in renal failure patients. A small diameter catheter is preferred to reduce the risk of vein thrombosis and PICCs are preferred for this reason. Right IJ sites are preferred because this is a virtual straigth path from vein insertion site to the SVC/RA junction and thus the risk of thrombosis is reduced. K/DOQI guidelines state that catheters passing through the subclavian vein should be avoided in renal failure due to thrombosis.
If you are asking about a PICC placed in the upper extremity with a tunnel, there is no evidence that this is necessary or beneficial. It has not been studied yet to my knowledge. A SC cuff on a PICC could help to stablize the catheter if it will be required for a long period of time, enough time for the SC tissue to grow into the cuff. This may required 2 to 4 weeks, depending on the patient.
Lynn
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
We had the same issue in our institution, IR will cut a power PICC to 16 or 20 cm and place it in the IJ or subclavian vein. They also would place tunneled power lines and tunneled power hickmans. The catheters are all made by Bard and look very much the same, could be confusing to the staff. This was solved by identifying the catheters by using a system of categories based on the method of placement. All catheters are place either tunneled or non-tunneled, with ports being the third category. Staff are taught to assess the catheter and identify the vein used, if possible, if not possible assess for a possible tunnel leading away from the exist site of the catheter. PICC catheters are non tunneled catheters placed in peripheral veins, catheters designed to be inserted as a peripherally inserted central catheter and then cut and placed in the IJ or subclavian is a non tunneled central catheter IJ or subclavian. This classification by category has lead to much less confusion.
Steve
Medcomp now makes a cuffed catheter that looks just like a PICC line. IR is using them at my institution. We have had to educate our own IV staff and general nursing.
Karen Bement