We have a patient who is getting vanc. BID. We have had to cathflo her PICC weekly and last week both lumens were completely occluded and the MD chose to rreplace the line on 4/2. This weekend she phoned that she is having difficulty flushing/infusing. She does not have any of the comorbidities that would increase the risk for this except she is a "larger" person. In the past we have had multiple issues with this brand of PICC and Vanc. infusions. Any suggestions ? Valorie
Hi,
I have had customers that had increased occlusions in catheters on patients receiving Vanco. They found a return to baseline if they flushed with 20cc of NS following infusion. They normally flush with 10cc following intermittent meds. They only flush with 20cc following blood, lipds, and now Vanco. It seems odd that it works but maybe the Vanco is enough of an irritant that 20cc help settle the response process at the catheter end???
Hope this helps!
Tom Billings, RN
ICU Medical, Inc
Tip location of the PICC is probably the most important contributor to this occlusion problem. If the PICC is not correctly positioned at the cavoatrial junction, there is a much greater risk of thrombus when it is higher in the SVC. How is the catheter secured? Is it changing in any way? Any changes means that the tip is also changing? You did not say what type of difficulty? Infusion pump alarms? Resistance to flushing? Lack of blood return? All of the above? There is no way to determine if your problem is intra or extra luminal without cathetergram. I have never seen occlusion correlated to a specific brand of PICC or even a type of catheter material. 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
Difficulty flushing then after a few days lack of blood return. I have always had this issue with this particular brand of PICC. Both of hers have had the tip confirmed in the SVC at the CAJ. My cathflo usage went to zero when our organization switched to the Navalyst xcela PASV 2 years ago (only have to use it when the patients have their PICC placed at other facilities who us the other brand). Coincedence? Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
The difference is the valve built into the external catheter hub of the PASV catheter. This valve prevents backflow of blood when the med finishes. Is this in hospital or home care? If a hospital, it sounds like the nurses are slow to return to disconnect and flush the PICC without the built in valve. If home care, the patient should be taught to immediately disconnect, flush and lock the PICC. 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