Tunneled Central Line Vascular Access Cases

TUNNELED CENTRAL LINE IN LTACH PATIENT | NCIA-38

Tunneled Central Line Vascular Access Cases: An LTACH patient with chronic kidney disease and respiratory failure, as well as a complex medical history that included lower bilateral DVTs and a pacemaker, needed to have an existing Vascath replaced with a Tunneled Permcath for long-term hemodialysis. The Vascular Wellness clinician performed a detailed patient assessment, noting the temporary dialysis catheter in the right internal jugular had been placed two weeks prior by someone other than Vascular Wellness. The clinician closely examined the line to determine if a catheter exchange could be performed, and quickly determined that a catheter exchange was contraindicated. The dressing was soiled with dried blood around the site, the line was sutured in several places, and the device had been placed high up in the neck – all of which made the patient a poor candidate for a line exchange. The clinician carefully removed the old large bore line, cleaned the site, and removed the old sutures. She placed a Tunneled Permcath lower in the neck without difficulty, and within ten minutes of completion of the procedure, the X-ray had arrived and cleared the Tunneled Permcath for immediate use.

TUNNELED, VASCATH, IJ, PIV LINES – ONE CALL DOES IT ALL | NCIA-50

Tunneled Central Line Vascular Access Cases: The care team for a patient in an LTACH ordered an Internal Jugular (IJ) Central Line so they could administer two intravenous therapies, and also requested the patient’s two Tunneled Central Lines be removed, as there was concern over infection in addition to the lines no longer being needed. Upon arrival the same day and case review, the Vascular Wellness nurse confirmed that the two PRN IV medications could be more safely administered via two ultrasound guided PIVs, which were more appropriate and less invasive than the ordered IJ. Additionally, the two PIVs together posed a lower risk of infection than a single Central Line (i.e., CLABSIs or Central Line Associated Blood Stream Infections), and they help preserve the patient’s veins and enable the facility to reduce Central Line days, as well as reduce costs. The provider agreed with the recommendation, the PIVs were placed, the Tunneled Central Lines were removed, and upon request by the provider, a Temporary Dialysis Catheter (Vascath) was placed for hemodialysis that the patient also needed.