Tunnelled central venous access devices. Gretta Moffat

At the CDHB we have been on a learning journey for some time.  In 2016 we introduced tunnelling of PICC lines using the methods that were picked up at WoCoVA 2016 by my colleagues who attended the conference.  We also had the introduction of Tunnelled CICC (PICC type of catheter) which was supported by the radiologists who taught the nurses how to do this.
I attended the AVAS/WoCoVA conference in 2017 and after engaging with the radiology consultants about the method, was able to bring back to the CDHB another method for tunnelling of PICC called Modified Seldinger Technique Tunnelling (MST-T), This method has also now been documented several times in journals and allows us to tunnel with a small variation in technique from a standard PICC Insertion.
I will talk about how to insert using this method, which allows us to follow the vessel health preservation tool that we use and maintain the skin insertion site within the green zone of Dawson’s ZIM. The limitations and advantages of using this method, and the clinical implications for us as a result of this.
I will then talk about what the other options of line we can offer if this is not suitable for the patient and a few of the cases that we have had.
We have continued to develop our practice as new innovations and evidence-based practice are introduced. I want to be able to give an overview of what we do as a vascular access service, challenges that we have faced and then newer techniques that we are using to improve that patient journey.

Gretta Moffat, RN, Diploma in Nursing 1995 CPIT
Gretta has worked in a variety of areas since training, General surgical/vascular, paediatric oncology and haematology, NICU and Radiology.  She has been in Radiology for 9 years now and had an interest in vascular access since starting in radiology. She also assist with all the other procedures that we perform within the department.
Gretta has been a PICC inserter for 7 years, Paediatric PICC inserter (From age day 0 and up including preterm babies) for 6 years, Tunnelled PICC inserter for 3 years, and Tunnelled CICC (chest inserted central catheter) inserter for 2.5years.  She has CVAD certification for implanted and non-implanted devices. She also did nephrostomy tube changes for the doctor’s, this enables them to be free to do other work as required.
Her ideal world would be a patient getting the right sort of access as soon as practical, so that they don’t end up coming for a line with ten dots up their arm, and extravasations from all of the IV lines that they have had, before getting what they need.  She would love to see a vascular access team set up at Christchurch Hospital to try and facilitate this happening.

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