I would appreciate this forum's comments on a probably semantic situation I have encountered at my new hospital. I have IR telling me that they place "tunneled PICCs in the IJ." OK, no big deal. I've heard of tunneled PICCs for use in femoral veins, why not the IJ? However, these "PICCs" have Dacron cuffs. I believe what they are actually placing is a tunneled IJ catheter. They say they are using this approach because some patients have stenosis that prevents access of the subclavian veins, so they tunnel to the IJ. I ask why they call it a PICC if it isn't inserted into a peripheral vein. The response is that it looks like a PICC, so that's what they call it. This approach concerns me for a couple reasons. First I think what one chooses to call a central line is important because it determines how the line will be cared for, maintained and discontinued. And secondly, a standard nomenclature should be adopted so obsessive nurses like me don't get hung up on a name! If it's truly a tunneled catheter with a Dacron cuff, the site shouldn't necessarily require a dressing in a non-immunocompromised patient once the exit site is healed. If it is actually a catheter marketed for use as a PICC line that has been tunneled for a special purpose, it will require a weekly dressing change and a consistent securement device(method) indefinitely as it lacks a Dacron cuff. If it's a PICC line, it would normally be discontinued by a competency-verified RN; however, a tunneled line secured with a Dacron cuff must be removed by IR at our facility. As an aside, I'm not aware of any studies that have demonstrated any infection control benefit of non-cuffed tunneled catheters ("PICC lines") commonly associated with the Dacron cuff in traditional tunneled catheters. I would appreciate this group's comments on this issue! Thanks,
Keith Gilchrist, RN, BSN, OCN, CRNI, VA-BC
David Grant Medical Center
Travis AFB, CA
I think you are correct to want clarification on the specific type of catheter being used. However I do not see any reason to introduce a new "type" of catheter. The reason for wanting to use the IJ is quite valid for renal failure patients or anytime the subclavian should be avoided. There are many brands of catheters used for IJ insertion including those designed and labeled as a PICC and those with a new design intended for IJ insertion in these situations. Some brands have a subq cuff and some do not. You do need to have the answers for your clinical questions but I think you need to learn exactly which brand of catheter is being used, the features of it, and manufacturers instructions. I wouuld not use "PICC" for any catheter inserted thru the IJ. IJ inserted CVCs have always been in the nontunneled percutaneous centrally inserted group. Sometimes the ones you are asking about may be tunneled but not always. This tunnel is not as long as the tunnel for a typical tunneled cuffed catheter. . 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
We are seeing these same lines being placed in IR and they ARE PICCs. They are tunneled into the IJ, and as you stated some have a dacron cuff and some don't. They are the size and gauge of our regular "arm" PICCs and I would never refer to them as anything other than an tunneled PICC. We treat them exactly like an arm PICC - the only difference is in the removal, as you stated. Our IR dept pulls the CUFFED tunneled PICCs, the PICC nurses pull the non-cuffed ones. We have tried to discourage the use of the cuffed lines except in obvious situations where the patient will need LONG term IV access, simply because the removal requires an appointment with IR if the patient has been discharged.
Wendy Erickson RN
Eau Claire WI
Makes sense. I didn't know there were cuffed PICC lines on the market. I was reading an earlier string on this subject and saw one institution that got around the confusion I was experiencing by describing all catheters as either tunneled or non-tunneled. Since all lines in either of these categories generally get treated the same way, it helped eliminate confusion. To me a "PICC" is in the arm and an "IJ" goes in the IJ! Cuffing a "PICC" seems unnecessary.
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA