Tunneled Catheter Fracture – Nurse Clinicians in Action-04

A patient with a tunneled catheter fracture and how the Vascular Access clinician removed the tunneled catheter at the patient’s bedside even though tunneled catheters are generally under the purview of doctors is the focus of this Nurse Clinicians in Action.

Tunneled Catheter Fracture

– Clinical Case

This case took place in a long-term acute care hospital (LTACH) where the patient required intensive rehabilitation after a long stay in a critical care hospital.  The patient was morbidly obese with a history of smoking and suffered a cerebral vascular accident (CVA), also known as a stroke.  Her mobility was severely limited, and this led to the development of a large sacral decubitus ulcer which became infected.  The treatment team at the critical care hospital placed a Broviac central venous catheter (a tunneled catheter with tip termination in the lower aspect of the superior vena cava, a large vein in the chest) to administer medications and fluids.  This decision was made with the knowledge that this patient would need long-term access to ongoing treatment for the infection.  After transfer to the LTACH, this central venous catheter was clamped at an improper location and led to a catheter fracture, a complication that can have serious consequences including bleeding, infection, and air embolism due to the non-intact catheter.

The LTACH physicians were uncomfortable removing the fractured tunneled catheter and consulted Vascular Wellness to place a new central line catheter, and when that was complete, the facility planned to transport the patient back to Interventional Radiology (IR) at the critical care hospital to have the fractured tunneled catheter removed.  This transfer would have been potentially hazardous to the patient because she was still on a ventilator, in addition to being a very costly exercise.  Because of the patient’s delicate condition, critical care transport would be required, which includes an RN, a Respiratory Therapist, in addition to transport drivers and EMTs for the round trip.

Tunneled Catheter Fracture

– Diagnosis and Treatment

The Vascular Wellness clinician understood the gravity of the situation, as none of the rehab doctors could remove the tunneled catheter.  Fortunately, this clinician had personally petitioned and received approval from the North Carolina Board of Nursing (BON) to place and remove tunneled lines.

The Vascular Wellness clinician consulted with the managing LTACH physician and proposed that not only could he place a new central line vascular access device, but he could also remove the existing fractured tunneled line right there at the patient’s bedside, eliminating the need for transport to another hospital.  This would significantly reduce the risk to the patient and remove the expense of the full care team that would be needed for critical care transport, as well as  the physician and personnel needed at the other facility.  The patient’s physician was intrigued and pleasantly surprised that in addition to the risk and cost of critical transport being eliminated, all the reporting and transfer paperwork required for such a move could be eliminated, as well.

 The Vascular Wellness clinician successfully removed the tunneled catheter without incident in the traditional manner and placed a new PICC which allowed the patient to continue the much-needed antibiotic therapy without further interruption and without leaving the facility.

Of note, the Vascular Wellness clinician saw this patient a few months later, and the patient had improved enough to be moved to a Skilled Nursing Facility.  She had lost over 60 pounds and was mobile and walking.  She was a much healthier version of herself than when she was first recovering from her stroke.  Seeing a patient’s progress is always very satisfying for all Vascular Wellness clinicians.

Vascular Access Specialist

– Key Points

Vascular Wellness believes deeply in its vision of Advancing Healthcare and Empowering Nurses.  Developing and furthering the Advanced Vascular Access Clinician role is core to this belief.  Vascular Wellness is a leading clinical nursing company as demonstrated by our nurses placing Small Bore Lines and Large Bore Lines, as well as our nurses using the latest technology for proper line placement confirmation.  The tunneled catheter program is just one of our advanced and cutting-edge skill sets among our nurses.

Vascular Wellness clinicians have placed hundreds of thousands of lines and this experience enables us to assess and treat a situation properly and if a line is damaged and needs to be removed, to be able to address the situation. Further, by having the tools of ultrasound (US) Guided PIVs, Midlines, PICCs, Small Bore lines such as Internal Jugular lines (IJs) and Femoral lines (Fems), Large Bore lines including Vascaths, Permcaths, Quad Lumens, and Tunneled central lines, Vascular Wellness is able to create clinically appropriate access in virtually all patients even in situations such as above when the tunneled line is fractured and needs to be removed or is not performing for any number of reasons.   These factors, along with a consultative approach with the treating physician, are just a few reasons why Vascular Wellness improves patient outcomes, reduces costs, and strengthens infection control.

Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician, as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA (Health Insurance Portability and Accountability) compliant communication app. In addition, our extensive training program and diverse client base, including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities, provide our clinicians with a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.

If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, Oklahoma, South Carolina, and Virginia; and
(2) Customized vascular access services to Arkansas, Delaware, Georgia, Mississippi, Pennsylvania, Tennessee, and West Virginia; and
(3) Support vascular access services to Ohio and Kentucky.