Just wondering what is recommended for persistent cvad occlusion - when you have instilled the two doses of cathflo with no success. Does this sound correct:
1. Chest x-ray to confirm tip location
2. Venogram
3. Cathflo infusion: 2 mg in 50 ml saline infused over 2 hours or overnight instillation
Thank you very much
Are you talking about 2 doses back to back or 2 doses given a month apart? Makes a big difference. First your assessment of catheter function and history of its use and patency should have ruled out the possibility of other causes of the occlusion such as drug precipitate or lipid sludge. For any type of occlusion, you should also confirm that the catheter tip remains correctly positined in the lower SVC. Tip migration could be the problem. If you think the problem is thrombotic occlusion it could be inside the vein around the catheter instead of inside the catheter lumen. Dye injection through the catheter under fluoro is indicated as this will show the retrograde flow of the contrast, also the fluid pathway of the infusing drugs. This can easily lead to extravasation injury. In that case the tPA infusion or catheter directed thrombolytics injection may be indicated. A venogram will usually ot show what you need and is invasive. An dopplar ultrasound can also rule out vein thrombosis. There is no clear algorthim. It is a matter of patient assesment and your judgment. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861