Friday, 9 May 2014

SENDING A PATIENT HOME WITH A NON-TUNNELED CENTRAL VENOUS CATHETER

Patients with non-tunneled long-term central venous catheters (CVCs) have been managed in home infusion, outpatient clinics, long-term acute care hospitals (LTACHs), and skilled nursing facilities for many years. This paper (link, below) discusses specific considerations when planning discharge, sample policies and procedures for care and maintenance in the outpatient setting. Controversy exists today in some areas of the country and particularly in the acute care hospital setting about discharging patients with non-tunneled CVCs. Data shows that these catheters are well tolerated in the above care settings.

Overview of Long-Term CVCs

Long-term non-tunneled CVCs are placed via the Internal Jugular, Axillary and Subclavian veins. These catheters may be placed at the bedside, in Interventional Radiology, or in surgery. Today, these devices are placed by physicians, nurse practitioners, registered professional nurses, respiratory care professionals, and physician assistants.

The use of these catheters dates back to the late 1980s. At that time, non-tunneled catheters were manufactured by a number of companies. Perhaps the best known of these were the Cook® Hyperalimentation Catheter (Cook, Bloomington, IN) and the Hohn® Catheter (CR Bard, Murray Hill, NJ). Available in single, double and triple-lumen configurations and made of silicone, they are still in use today. In recent years, newer polyurethane and power injectable polyurethane long-term non-tunneled CVCs have been introduced.

Tunneled catheters with cuffs (Dacron) or other materials, including cuffs with antimicrobial properties) are often used for long-term therapies. These have long been a catheter of choice, by some physicians, for the pediatric population. These catheters are available in pressure injectable polyurethane and non-pressure injectable silicone versions.

Peripherally Inserted Central Catheters (PICCs) have been a popular long-term central catheter option for more than two decades. Commonly used in both inpatient and outpatient sites of care they are often thought to have a lower risk of complications than other central access devices.

Summary

With current recommendations to avoid peripherally placed venous catheters in patients with Stages 2-4 renal disease, and the fact that many other patients may not be candidates for peripheral access, an alternative is required. Careful assessment and evaluation of each patient to determine the most appropriate vascular device should be common practice.

When performing a vascular access assessment it is important to consider many factors. These factors include potential for discharge with a vascular access device, patient and primary care provider understanding of the risks, benefits and care/maintenance and availability of health services in case of complications. Long-term non-tunneled CVCs are an option for patients that are leaving the hospital with a vascular access device.

For a full copy of the White Paper on this Topic click here:

For more information on device selection and patient assessment return to homepage www.vesselhealth.org.


Jim Lacy, BSN, RN, CRNI is a Product Manager for Teleflex and  current President of the Board of Directors of AVA.

Posted by TopicsInVascularAccess at 2:28 PM in /
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