Lines and Catheters¶
Ahman Dbouk and Samuel Lazaroff
Foley Catheter¶
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Indications: urinary retention, close urine output monitoring in critical illness or renal failure, need for strict I&Os (ex: diuresis) and unable to be achieved without catheter, surgery, open sacral/perineal wounds with incontinence, patient comfort at end of life
- Urinary incontinence alone is not an indication for foley catheter
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Duration of use is biggest risk factor for CAUTI
- Best way to prevent CAUTI is to avoid inappropriate placement
- Assess daily whether foley can be removed
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Chronic Foleys generally should be exchanged at time of admission
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Any concern for catheter obstruction (particularly with blood clots) should prompt urgent urology consult for irrigation/intervention (typically after RN has attempted)
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Difficult foley placement
- Make sure an attempt has been made with a Coudé catheter. This catheter has a curved tip that can be useful in patients with BPH
PICC¶
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Single lumen: long term Abx, stable IV access with intermittent draws
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Double lumen: special populations (ICU or chemo), TPN w/ lipids (incompatible with many IV medications)
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Risk factors for CLABSI/VTE: ↑↑duration, ↑↑number of lumens, left arm, lower extremity
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A note on midlines:
- A midline is just a long PIV inserted into the deep veins in the arm, typically 6-15cm
- For reference, when you place an US-guided IV, the “long” 18G needles at VUMC are 2.5 inches (~6.4cm)
- Not much benefit compared to US-guided IV. Useful for stable IV access for meds and fluids. Not a stable route for blood draws
- A midline is just a long PIV inserted into the deep veins in the arm, typically 6-15cm
G-Tube¶
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Troubleshooting: EGS consult for malposition/not functioning, wound consult for skin breakdown
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G-tube study: 30mL Gastrograffin via tube [resident often must push], and order KUB