Hi Everyone,
What are the current recommendations when utilizing thrombolysis to declot multilumen catheters ? Declot ONLY the affected line or treat ALL the lumens as a prophylactic measure ?
Dave B
Hi Everyone,
What are the current recommendations when utilizing thrombolysis to declot multilumen catheters ? Declot ONLY the affected line or treat ALL the lumens as a prophylactic measure ?
Dave B
I am not sure there are any official recommendations. I have learned over the years in my practice I have better outcomes declotting all lumens "most of the time" especially when you try to aspirate and can "feel" the fibrin tail. There are rare occasions, depending on risk factors, when we have to do more frequent declottin. Hope this helps. Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
The site cathmatters.com probably has info about this, or of course your rep. Treating all the lumens is a sure thing, but expensive and might be unnecessary. We have been treating the most occluded lumen and allowing for a full 2 hour (or longer) dwell. We have had very good outcomes with this, in fact I can't recall a PICC that required another dose. We are treating inpatients, our own PICCs rarely need Cathflo but we treat a fair number admitted from LTACHs and such with a PICC in situ.
I would not expect a local sales rep to provide this information. Many would tell you to treat both lumens because it is going to mean more product sales and increase his/her commission. So pay attention to the source of all product information. Some sales reps would not provide this information and direct you to the clinical staff in their company, which is appropirate. I have not seen any studies assessing this aspect of care. There could be many differences between catheters. For instance, a CVAD with non-staggered lumen exits may have fibrin covering both lumen exits and need both lumens treated. A CVAD with staggered lumens may only have a lack of blood return and/or resistance to flushing from a single lumen. The decision to treat both lumens should be based on a careful and complete patient assessment in the absence of any evidence to guide this practice. 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 consistenly see good results if I treat one lumen when there is a withdraw occlusion of 2 or 3 lumens that are not staggered. Also, when there is a complete occlusion in one lumen and partial of 2nd, 2mg in one lumen works well. If the lumens are staggered I treat whichever lumens are occluided up to total of two 2mg doses/24h.
Nancy Rose
When the drug studies were done, it one dose was used to treat a multi-lumen cath and cath function was resotred I believe it was like 85% of the time with the first dose and 95% of the time with a second dose instilled after 2 hrs if no blood return noted. With a staggered multi-lumen line, it is best to try to instill it in the most proximal lumen so that it can bind to any fibrin that may be on the catheter and then it will go to work on restoring function to all lumens. With a multi-lumen cath that does not have staggered lumens, I have had best results when it is withdrawal occlusion to instill the medication in the middle lumen and allow it to stay for a full 2 hrs, even with fluids/meds running in the outter 2 lumens, and have then been able to get a brisk blood return from all lumens.