We have had an increase in the 4.2Fr Broviac catheters ballooning and breaking in our pediatric population. Does anyone know of any literature supporting preventive alteplase dwells to prevent occlusions?
We have had an increase in the 4.2Fr Broviac catheters ballooning and breaking in our pediatric population. Does anyone know of any literature supporting preventive alteplase dwells to prevent occlusions?
There has been at least one study using alteplase as a substitute locking solution instead of heparin. Do you have information, usually for radiology, that the occlusion is actually inside the lumen? The majorty of occlusions are coming from what is in the vein surrounding the catheter. A locking fluid would only have an impact on the fibrin/thrombus directly at the catheter tip and not the entire length of the problem. 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 have also had breaks in this size of Broviac. We have been working with Bard to identify the problem. I also agree with Lynn, alteplase would only deal with internal issues. The problem is the breakage, which has to be addressed at the manufacturer's level.
Janine Pritchett, RN-BC, BSN, VA-BC
Clinical Educator - Vascular Access
Could the breakage be related to too much pressure applied from syringes? Are nurses using normal force to move the plunger or do they apply more force when they meet resistance? 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
In investigating our last 2 instances: one patient's Brovaic was clamped multiple times on the wrong part of the catheter and was getting multiple blood draws. The second incident involved our CRN called to repair the line and noticed the internal lumen had obvious clotted blood. We are looking at a reeducation need and possible change in practice using a dedicated team for blood sampling and flushing.