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Discussion

Use of Cordis

Hello. I am trying to research some information on clinical practice. I work in a cardiac telemetry unit, which in my hospital is considered a medical surgical unit. We care for open heart surgical patients along with many other cardiac patients and also take care of critical drips. I am hoping to find out what kinds of units out there minus critical care take care of and maintain a cordis and/or pull them. Any help will do and it would also be helpful to know in which state you practice. Thank you in advance for your help in this endeavor. Sincerely, Erika Szell

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    By "cordis" I assume you're referring to an IJ introducer. AACN recommends that patients with any type of introducer should be in a 1:2 ratio due to the high risk of rapid exsanguination either because it comes out or because the cap comes off an unclamped introducer. In reality though it's not unheard of to find them on units with up to 6:1 ratios, mainly in post OHS patients. And it's even less unusual to find them on step-down units, with or without a swan still in place, which are 3:1 or 4:1.

    I've had many a patient pull out their own IJ introducer on a telemetry unit (1:5 ratio for OHS patients) and wasn't aware of it immediately and each time the bleeding is surprisingly small, although air embolus is also a large risk. That doesn't mean though that I haven't just been lucky and it's quite possible for this turn out bad very easily.

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    Hmmm... I was thinking of Cordis as the brand name. I'm pretty sure our triple lumen central catheters are made by Cordis, although I could be wrong. Perhaps some clarification from the OP, especially as she is using a brand name rather than the generic?

    Our patients with sheaths (with or without a swan) are restricted to either ICU or the intermediate care unit. Our cardiac tele floors will take patients with a triple lumen central line, as will some other floors (I'm most familiar with open heart patients since that's where I work).

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    "Cordis" is medical product division of Johnson & Johnson and produces a variety of medical products, mainly in interventional cardiology, yet it's become synonymous with an IJ introducer.

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    Our OHS patients have their IJ introducers left in for up to 7 days. They are sutured in place and must be capped before leaving ICU. Our ratios are up to 4:1 on our cardiac tele floor.

    We treat them as a central line: chlorhexidine to scrub the hubs, removing them with the patient in Trendelenburg and performing a Valsalva maneuver during removal to decrease chance of air embolism.

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    We call them MACs at my facility. We try to pull them before sending the patient to step down, but if can't get two good peripherals we may leave it in. I am surprised to read that the AACN recommends a 2/1 ratio--That seems a little silly to me personally.

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