Happy New Year everyone.
I have a few questions regarding catheter occlusion management.
What is your protocol for management of central venous catheter occlusion ? (If you prefer, you can email me the protocol rather than rewrite it in the forum.)
What dose of thrombolytic does your institution administer ?
Does anyone use 1mg/2ml vs 2mg/2ml of thrombolytic and why ?
Thanks,
DB
You should ALWAYS use the 2mg/2ml as this is the label and how it was tested. There is no guarantee that the 1mg/2ml will be effective, so why waste the time and money. An occlusion is not just a total occlusion where you are unable to infuse, but also, if you cannot obtain a free flowing 3ml blood return. Genentech has some awesome pics that show the fibrin sheath on the end that is preventing the blood return yet allowing you to flush or push meds. You should never ignore a withdrawal or total occlusion just because you have another functioning lumen. The potential for CLABSI is increased by doing this. Also, it will totally occlude the good lumen at a most inconvenient time.
I teach for Genentech so my info comes straight from them. I've been doing this since 2006. Also work in a home infusion company. If you wish to communicate with me off line, email me at [email protected]. I love to share my experiences and knowledge of IVs.
Good luck!!
Ann Williams RN CRNI
Infusion Specialist
Deaconess Home Infusion
Evansville, IN 47747
812 450 3828
I have heard other state the need for a 3 mL blood return to assess a catheter. I do not know where this is coming from but it is not a standard of care. There is no requirement to absolutely pull back 3 mL to determine lumen patency. You need to obtain a blood return that is the color and consistency of whole blood but there is nothing stating or mandating or requiring a specific volume of any amount. 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