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Correspondence |
We read with interest the report of Barnacle and Mitchell [1] describing their technique of using ultrasound guidance in the removal of tunnelled venous access catheter cuffs.
We lead a "Nurse and Radiographer, Central Line Insertion and Removal Service" within our trust. For catheter removal we prefer to use a cutdown technique under local anaesthetic rather than manual traction to avoid the retention of the cuff and discomfort to the patient.
We agree that in some cases where the patient is particularly large or oedematous it can be difficult to locate the cuff by palpation. Although we did try an ultrasound visualization technique, we found that a simpler method was equally as effective in locating the cuff.
On examining the lines we insert, Bard, 9.6 Fr. Single-lumen Hickman Catheter (Bard, UK), it was found that the length of the line from hub to cuff remains constant. Therefore, by measuring the line length in the patient using a tape measure we can easily locate the cuff and mark its position.
This technique enables us to remove lines safely without the use of ultrasound equipment, which can be utilized elsewhere within the department. We suggest that central line manufacturing techniques are such that each individual make of line will also have a constant distance from hub to cuff, therefore this technique can be applied to the majority of cuffed lines.
Yours etc.,
South Manchester University Hospitals NHS Trust, Department of Radiology, Wythenshawe Hospital, Manchester, M23 9LT, UK
Received for publication March 17, 2005. Accepted for publication March 21, 2005.
References
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