I have heard of the practice of exchanging an occluded PICC without using a guide wire. The practice as described to me is that the PICC is partially removed and cut with scissors just like an over the wire exchange, but because then PICC is occluded, a wire is not inserted. A dilator/introducer is used. The dilator portion is removed and the PICC is fed through the introducer and the introducer is inserted into the vein over the PICC. Is this a common practice? I have heard this used for groshong PICC exchanges also. My first reaction as many of my peers was no we do not do that, but I wanted to use this forum to find out the truth. I have net seen this in the INS standards. Is this supported by INS?
I have not heard of that type of catheter exchange. Although, I must say it intrigues me.Off the top I can't think of a really good reason you can't do it that way. I'm sure you hear opinions on both sides. I would say there must be someone out there doing this if you have heard about it. Could you please let us know where you read that.
Jack Diemer
Exchange through an introducer is an acceptable procedure BUT all exchange procedures should be very rare and carefully considered. They increase the risk of BSI and are never done unless the benefits to a specific patient outweighs the risk. Check the INS Standards #55 on Exchange. INS standards are not meant to be about procedures so specific techniqiues would not be addressed. Also, this procedure may be discussed in the INS textbook. I would hasten to ask why an occluded catheter would need to be exchanged. Has a thrombolytic agent been used and failed? Is this a drug precipitate that requires another type of clearance drug instilled? Is it a malpostioned catheter that is now located in a smaller vein? Is there a vein thrombosis causing the occlusion? You must do an assessment to determine what caused this occlusion and treat that first before doing any exchange procedure. 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
Thanks for your responses. I do not know the specifices of the procedure, but the nurse told me that if the line was lost, it would have been very difficult to place anew one. Again, I do not know the specifics of the clinical picture. I agree with the assessment aspect as for as a declot or preceiptate. But again, I do ot know the whole story. One of our RNs haa concern of the PICC material being shreard off by the dialator portion. I will check out the resources as Lynn mentioned.
David Dempsey MS, RN
Before the days of power-injectable PICCs, we used Groshong singles and duals, and yes, this is how we did the very rare exchange. It makes sense to use this method with an intraluminal occlusion as well, if there is no other recourse for replacement.
Patti Dickinson CRNI VA-BC
Lawrence Memorial Hospital
Lawrence, KS
This method is described by Beth Fabian here: Fabian, Beth; Peripherally Inserted Central Catheter Exchange Using a Breakaway Sheath. JIN, 18:92-96, 1995