I attended AVA this past November, and took the CVC insertion couarse which was FABULOUS!, but I am just needing to know from those who are doing this... do you cut PICCs and insert into the IJ or are you using the Hohn catheter?
I attended AVA this past November, and took the CVC insertion couarse which was FABULOUS!, but I am just needing to know from those who are doing this... do you cut PICCs and insert into the IJ or are you using the Hohn catheter?
We have been doing IJ Picc's now for about 2 years. I use our current Navilyst PICC and access the IJ using ultrasound. My suggestion for starting that procedure is :
1)Let your IR physicians train you. I watched an IJ inserted in IR, then I inserted 3 in IR with the MD watching.
2) When your ready for bedside , Go with 2 RN's. It's a little different setup and you'll need to put the bed in Trendelenburg and get to the head of the bed. So at first, I would suggest having 2 RN's until you get comfortable
3) Always be aware of the danger of attempting this. Keep it always in your mind. If you do, you'll assure yourself that your doing it safely.
4) Have fun!...This is a great procedure that we as nurses can do. It just makes you MORE valuable to your institution and helps all those renal patients get access quickly and safely. I'm always a believer that nurses do procedures with a certain level of expertise and care that is unmatched. So good luck.
Jack
I'm so glad you enjoyed the class! It was a great day - so much energy!
I place Hohn's or Arrow Blueguard + catheters (depending on the patient's need). I do not trim PICC's for IJ, Subclavian, or femoral placement. There are excellent catheter choices available that are indicated for central insertion. I would stay away from off label use of PICC's.
Kindest regards
Judy
IJ PICCs are a great addition to any vascular access nurses skill set. I have placed many PICCs "off label" in the IJ.
Remember the restriction is on the manufacturer and their marketing of the product, not the clinician who makes a reasonable and prudent decision to do so. There are more than a few hospitals that have been using PICCs "off label" for years now with great results. I have also used the Hohn as well as the Powerline. As far as statements like "I would stay away from off label use of PICCs" .....without any clinical reasoning or followup I think the statement is irrelevant. Why would you stay away? As a clinician I can see no compelling reason not to use PICCs in the IJ when clinically indicated. KDOQI guidelines even say to use a "small bore catheter". I guess I have a pet peeve of fear mongering when nurses say to each other "I wouldn't do that if I were you" and then give no reason why not!!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
I agree with Steve.
I remember when cutting a PICC was considered "off label". Why not use a PICC for an IJ...It can go in the arm but not the neck?. We need nurses that think. My whole career I have heard. "We do it this way.." or "you never do this..." no clinical reason it's just because that's the way we've always done it. We as a profession we need to move away from antiquated thought processes and depend on clinical expertise.
Cutting or trimming a PICC has never been considered an off-label use for any PICC. From the early days of PICCs back in the 1980's, instructions for use have always included information about trimming the PICC. The only exception to this was for those catheters that had a preformed catheter tip molded to be rounded or have a special material used to form a softer tip or have staggered exit lumens at the catheter tip. So cutting is not off label. But there is very little clinical evidence about outcomes with the practice of trimming. We do have credible evidence that cutting at the bedside can produce jagged edges or hanging pieces. What does this mean clinically? We simply do not have clinical evidence to link this to any outcomes yet.
The off-label use comes when you take a catheter designed and labeled for insertion into veins in one location in the body and insert this same catheter into a location that is not included within the manufacturers instructions for use. So do not throw away those booklets on the top of each catheter package. Read them! This defines what is and is not considered to be off-label. Off-label means that the manufacturer is limited in how they can promote this practice. The instructions for use provide a guideline from the manufacturer about the most appropirate use of that product, however the clinician can alter that if it is thought to be in the best interest of the patient.
I can tell you without hesitation that these instructions for use will be used in any legal case if one occurs. If you have practiced in a manner that is not included within that products instructions for use, then you will need to document thoroughly your thought processes for what led you to that decision including the factors you considered, how you altered the instructions and/or product and why you did it. If all of that is documented, you will be in a very strong position in such a lawsuit. Without such documentation, your position will not be so good. I hate to use the threat of a lawsuit to get anyone's attention, but I am simply trying to draw your attention to the extreme importance of what you include in your documentation if you chose to use any device in a manner that is not within the instructions for use. Your documentation could either save your or cause you to loose the case. Based on this fact, I would prefer to use a catheter designed for insertion into the IJ rather than altering one that was designed to be inserted into the extremity. If your concern is the catheter's outer diameter and one designed for IJ insertion is not small enough, then protect yourself by documenting that fact. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861