Hi,
I was wondering if anyone could help. At my institution we do not routinely cxr for occlusion problems unless there is a clear reason such as the change in the external length of a PICC. As far as I can tell, occlusion care standards, including CVAAs do not call for a routine cxr before attempting to restore patency with cathflo. An online course I just completed had the appropriate action for a withdrawal occlusion as a chest xray. Any clarifiation would be helpful.
Kerry McDonald
A change in the external catheter length indicates catheter dislodgment where both ends of the catheter has changed positions. There is also catheter tip migration where only the internal tip location changes but not the external length. Tips can move to IJ, contralateral subclavian, or other smaller veins and produce a tip location that comes close to the vein wall and produce vein thrombosis. This can only be determined by a chest xray.
There are no clear recommendations for whether you should do a chest xray first or do the tPA first. That would be a decision for your policy committee(s)
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
Those are the situations where we ask for chest x rays, not for routine assessment purposes of withdrawal occlusions, Thanks .
K.McDonald RN
The only sign for tip migration can be withdrawal occlusion and there is no way for the nurse to know if the tip has moved without an xray. 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
Hi again Lynn,
We do an xray if withdrawal occlusion persists after 2 treatments of cathflo, (each dwell of 2 hours) or if it is a repeating issue. Love the site! Keep up the good work.
Kerry
K.McDonald RN
That sounds reasonable. 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