We are developing our CVAD policy. Our question is regarding de-clotting: is it necessary to include the stop-cock method in our policy? Is there an algorithm helping to decide which method should be used in a complete occlusion? We prefer the single syringe method - creating negative pressure by pulling back to the 8 ml mark. We find it to be the simplest and also find it to be very effective. Do we need to include the stop-cock method?
Thanks very much
Why not have a policy which covers both procedures? We allow our nurses to use whatever declotting procedure works best for the situation.
How do you decide which procedure is best for each situation? When would the stopcock procedure be preferrable?
Thanks
Both methods work for me, as well as for my fellow employees. Some times though it is just a matter of whether I have run out of stopcocks. However, I also find that when the occlusion has been occurring for hours, it is easier for me not to use the stopcock method.
We use the stopcock method for full occlusions but sometimes can spend a lot of time just to instill the alteplase. I have not heard of the single syringe method. Can you direct me to information on that? Do you have reference information and/or guidelines on how the single syringe method is done? Thanks!
Staci Krebel, BSN, RN, VA-BC
Clincial Development Manager
Biolife, LLC
Sarasota, FL 34243
314-807-3631
Genentec will send you a free DVD if you go to www.cathflo.com or you can watch it on line at Vimeo. I'll try to post a link (this computer is blocked for videos). www.google.com/url
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
There are several how-to articles on declotting that discusses the syringe method, although I can't give you a specific reference. Basically, the syringe is attached and catheter is aspirated of fluids between the thrombus and hub. Before disconnection a clamp is closed on the catheter to maintain negative pressure inside the lumen. The syringe with the thrombolytic agent is attached, clamp opened, and the negative pressure pulls the agent into the lumen. 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
I've never felt the stopcock version to be any more helpful, it adds expense and is a lot more confusing. It's been removed from our procedure.
You didn't ask, but I thought I would share a few thoughts on using tpa for those who are mystified by the process .
I mix the drug in a 10cc syringe and prime a new needleless connector with the drug, remove the old connector and attach the new one with syringe attached. (This helps get the drug a little closer to the clot). Slowly pull and release the syringe several times which facilitates mixing of the drug with the solution in the catheter. I use a connector because I don't like leaving the syringe attached and unattended. It's my personal preference. I also "imagine" that the positive pressure from the connector is somehow helping the drug to diffuse more quickly. (Talk about not using evidence based practice, lol )
If the tpa had color you would see it slowly work down the line. There will be no change in the volume of the syringe since there is nowhere for it to go. Diffusion will eventually carry the drug to the clot.
In multilumen catheters there is a potential hazard, you can cause negative pressure and blood reflux in the open lumen. I have actually occluded open lumens in the process of aggressively trying to declot the other. To avoid this, attach a saline syringe to the the open lumen and give it a small flush after every negative pressure manuever in the clotted lumen. I suppose it would make good sense to flush all lumens after a blood draw for the same reason. Hmmm.....
Darilyn
"In multilumen catheters there is a potential hazard, you can cause negative pressure and blood reflux in the open lumen. I have actually occluded open lumens in the process of aggressively trying to declot the other. To avoid this, attach a saline syringe to the the open lumen and give it a small flush after every negative pressure manuever in the clotted lumen. I suppose it would make good sense to flush all lumens after a blood draw for the same reason. Hmmm....."
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Darilyn--Thank you for thinking the above thought out loud--For the exact reason you stated with multilumen OPEN ended catheters--specically PICCs--The potential for the "non occluded" lumen to occlude during or after instilling tpa is why I treat the whole catheter with tPA--There are instances when this is not practical because a therapy infusing through the "non-occluded" lumen cannot be stopped--But if I have one hour to treat all lumens at the same time I do
Robbin George RN VA-BC
Robbin George RN VA-BC
In my organization, we use only the single syringe method. It is easier to use, and most of the clinical areas do not carry stopcock anymore.
Policies and Procedures for Infusion Nursing 4th edition from the INS contains both methods for complete occlusion and the procedure for each method is spelled out on pages 97-99