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Referrals

We encourage early referral for a suitable vascular access device to improve patient experience, preserve vessel health/preservation and effectively facilitate IV therapy.

 

Please note : Vascular access is a nurse led service, not all patients are suitable for referral.

 

PERIPHERAL CENTRAL VENOUS CATHETER (PICC) / MIDLINE Catheter

 There is no restrictive exclusion criteria for PICC or midline catheter insertion. You may consider omitting low molecular weight heparin or correct low platelet levels in the unlikely event that a PICC / midline is unsuccessful and may require to be converted to a tunnelled line.

 

CUFFED TUNNELLED CENTRAL VENOUS CATHETER (TCVC)

  • APTT ratio must be equal to or lower than 1.6
  • PT no higher than 16
  • Platelets must be above 40 (if platelets between 30-40 VAS will consider placing a catheter with platelets running following discussion with medical staff)
  • Low molecular weight heparin (LMWH) must be omitted 24 hours prior to procedure
  • Patient is able to lie flat

PATIENTS NOT SUITABLE FOR NURSE LED SERVICE

  • Known venous stenosis, SVC obstruction or central venous stent in situ
  • Significant mediastinal disease
  • Recent myocardial infarction (within 2 days)
  • Pacemaker in situ
  • Current pneumothorax

If patient has these symptoms please refer to interventional radiology service.

 

Patient Referral to the Vascular Access Service:

All patient referrals are made via TrakCare. Please follow the process below:

  • Input the patients community health index (CHI) into trak
  • Click on Episode Tree
  • Select current episode
  • Click on 'New Request'
  • Under Imaging:
  • For PICC line insertion : Input 'IPICCI' into item box
  • For TCVC insertion input  'ITCVCI'
  • For TCVC removal 'ITCVCX'
  • For TCVC exchange 'ITCVCG
  • For Haemo-dialysis insertion ' ITUNDI'

For insertion of TCVC - all patients must have a recent Coagulation (Coag) and Full Blood Count (FBC) (within 2 weeks provided they have received no treatment)