A debate surfaced in the neonatal literature over two years ago questioning the safety and efficacy of trimming peripherally inserted central catheters (PICCs) prior to insertion. An investigation was undertaken to define the risks and benefits of doing so and evaluate the methods of trimming PICCs. When trimmed by 1 of 3 methods, conclusive evidence revealed that the method of catheter trimming affects the integrity of the catheter tip. Additional study is required to determine whether catheter tip alteration impacts patient outcomes.
This three-part series of articles (parts 2 and 3 will be published in the Spring and Summer 2007 journal issues, respectively) will include information appropriate for the novice and the expert vascular access nurse. The series will include primers on vascular access devices, along with review of skin cleansing agents, dressing materials, catheter flush solutions, and injection caps. The focus of the article series will be the issue of catheter-related bloodstream infection, practice, technologies developed to prevent or decrease infections, current standards, and guidelines and preventive strategies.
Traditionally, heparin-lock solution has been used with all central venous catheters. The introduction of new technology calling for the elimination of heparin and the growing concerns about the use of heparin have caused many health care professionals to question its continued use for this purpose. This literature review attempts to answer the most common questions using available research; however, there continues to be more questions than answers. At present, it appears that some farm of anticoagulant will produce more patent catheters, and heparin-lock solution is the only product commercially available. This situation drives the need for a careful assessment of patients' needs prior to abandoning the use of heparin.