Is anyone experiencing a shortage of Cathflo? We are unable to order any. Our purchasing director was told there is a production problem and may not be available until mid May. Being a small home infusion pharmacy we are definately a lower priority. Any ideas as to what to do in the meantime?
Marianne Valentine, RN, CRNI
PharmaCare Infusion Services, Cumberland, MD
Are you home infusion or ambulatory care? Double your efforts to teach patient and caregivers the correct flush-clamp-disconnect sequence for the type of needleless connector being used. This is critical for avoiding blood reflux and thrombosed lumens. Teach patient to immediately disconnect and flush without delay. Delay causes blood reflux and it may not all be flushed out adequately. Insist that everyone rigidly adhere to these methods without compromise. Ensure that all CVADs have the correct tip location before you accept the patient as incorrect tip locations produce more vein thrombosis. Teach patient to avoid strenous, repetitive physical activity with a PICC - muscle compression could also compress the catheter forcing locking fluid out and blood to reflux into lumen.
If you still have a problem with these best practices in place, you can consider the use of retaplase or urokinase. These may need to be aliquotted in 10 mL syringes and frozen by your pharmacy. But first I would try to drive down the need for a thrombolyitc in th first place. 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
We were just notified of this also. I am with a hospital based Home Infusion company so I have also been invoved with the discussions at the hospital. Hope the problem is quickly resolved. I do wonder what the issue is.....Thanks Lynn for your thoughts. this is what we have discussed here, that we are going to have to educate to get better/proper flushing and maintenance of the lines.
Yes, Lynn, we are a home infusion company. I will definatley reinforce all of your recommendations to our patients and forward this information on to all of the home health agencies and nursing homes we work with in the hopes of reducing the problem to begin with. Thank you very much!!
Marianne
Marianne Valentine, RN, BSN, CRNI
Nurse Manager
Pharmacare Infusion Services
Cumberland, MD
Please refer to drug shortages under alteplase on ASHP website. They have made temporary recommendations.
American society of health-system pharmacists
Your pharmacists can work with you to handle this situation so I would defer to your pharmacist for help. Proper care and maintenance can help but it does not off set all occlusions. Especially those that occur as fibrin tails at the tip of a catheter. Flushing is an internal not totally external measure. The Triad of Virchow stiill applies to a device.
We will make it through this as we did with the elimination of Abbokinase in 1999-2000 time frame for catheter clearance. Work out a plan with your pharmacist as soon as possible
As a home care provider if the line is clotted and you have no solution send the patinet to outpatient at the hospital for catheter clearance. That is my only recommendation if aliquotting and freezing is too cost prohibiitive to the small home infusion agency.
Kathy Kokotis
Due to the shortage of Cathflo Activase and our need for it we, pharmacy, are going to be preparing syringes of Activase for use for catheter clearance.
I have read about the process of diluting it with sterile water, preservative free , and filling sterile syringes with 2ml/2mg dose in syringes and freezing them. My question is??? what is the proper way to defrost these?
I pulled up some old info/policy on line and it made mention of rolling syringe in palm of hand. Another policy just says to not put it in the microwave to thaw it out.
Any tips or recommendations?? thanks, Gina
Gina Ward R.N., VA-BC
Our pharmacy never stopped alloquoting unused tPA
[eg If tPA is ordered for an ED patient but the product is not used for whatever reason the drug is not wasted but instead alloquoted]
If you receive the syringe and it is still frozen or only partially defrosted you can gently roll the syringe between you hands but avoid shaking or agitating the product
Robbin George RN VA-BC
Our pharmacy never stopped alloquoting unused tPA
[eg If tPA is ordered for an ED patient but the product is not used for whatever reason the drug is not wasted but instead alloquoted]
If you receive the syringe and it is still frozen or only partially defrosted you can gently roll the syringe between you hands but avoid shaking or agitating the product
Robbin George RN VA-BC
Please comment on the following scenarios without the option of Cathflo:
Patient receiving end of life care. Currently treating small bowel obstruction. Has a dual lumen PICC, infuses without resistance but has no blood return. Tip location is cavo-atrial junction and pt is difficult venous access. Would you remove the PICC?
Patient with dual lumen PICC, 5 more days of Vancomycin therapy. 1/2 lumens is completely occluded. The non-occluded lumen has blood return. Cavo-atrial junc tip location. Not a difficult venous access. Would you remove the PICC?
Thanks for your opinions.
Nancy Rose
Use urokinase or retaplase that has been aliquotted by your pharmacy. I would not remove these PICCs until I had tried these other drugs. They are equally as effective as alteplase. What is being infused for the end of life patient? If a vesicant, I would want to know if there was a fibrin sheath that could cause retrograde infusion. Vanco patient for 5 more days - a matter of weighing the risk of infection from the obstructed lumen and increased risk and cost of inserting a new PICC vs benefits of using the open lumen for the remainder of therapy. Document all thought processes behind your decisions. 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
The company is resuming normal distribution today, March 25th. We have also been notified that some rubber stopper material has been discovered in the vial, therefore, we must reconstitute as normal and withdraw using a 5micron filter needle.
Our pharmacy is going to dispense product with the needle as this is not something nursing has available.