Dacron cuff of Hickman pulled out

[holdensjane]

What do you do? Its just pulled out enough to see the cuff. Surgery recommended to come out but didn't seem firm as patient still needed treatment. Attending says okay to keep but don't know if its bc Dacron cuff is trivial or if they don't understand the implications. Surgery won. What is your standard of practice?

[iluvivt, BSN, RN]

The first thing you need to do is gather some additional information with a critical one being: Where is the catheter tip located? Depending on the brand of course, the Dacron cuff is is usually a few inches from the exit site of the catheter so if you can see a little bit of it that means part of it may be still adhered to the SQ tissue or not. You can give it a very very gentle tug to see if it is adhered or if it will just slide right out. It is better if it is adhered if you are going to leave it in. If it is not adhered you may still be able to leave the CVC in but you will lose the benefit of the Dacron cuff which not only keeps it securely in place but in theory is supposed to reduce the risk for infection. It all depends on the assessment and is decided on a case by case basis.

The other pieces of information you need are: How long is the proposed lenght of treatment? What is the status of the central vasculature including the liklihood of gaing access again and what therapy is the patient receiving (ie. TPN,chemo,etc). All of these factors need to be taken into consideration when making the decision. I have seen both done.....replace and leave it in place. The tip placment is critical because the further away you get from the cavoatrial junction the greater risk of EVERY complication especially thrombosis!