A patient has a triple lumen PICC, which after lab draws the proximal lumen is clotted. visable blood is noted in the lumen. Cathflo has been used but did not work. The distal and middle lumen are patent. To me this seems like a non functioning PICC and the risk for the patient getting a catheter related infection should increase. Can you please lead me in the right direction.
Thank you,
Michelle Waldo
Why was a triple lumen PICC inserted? Is there the true clinical need for 3 lumens? For Cathflo to not work is strange. It could be the fact that the tPA did not reach all of the solid intraluminal thrombus. There could easily be intravascular thrombosis around the tip. What you instill - either flush or lock solution or tPA will not reach what is inside the vein around the catheter. Where is the documented tip location? If it is not at the cavaatrial junction, now you have 2 risk factors for vein thrombosis - large catheter size and suboptimal tip location. I can not recall any evidence indicating that a thrombosed lumen increases the risk of CRBSI. But you know that thrombus will also have biofilm. If pieces of that thrombus breaks off it will move into the bloodstream where it can cause CRBSI. After a complete patient evaluation of their needs, risk factors, length of therapy, etc, I would determine the best avenue which would include one of these:
1. remove this catheter and insert a single or dual lumen PICC if that will meet the patient needs.
2. perform a catheter exchange through one of the patent lumens, replacing with a single or dual.
It do not think it is acceptable to do nothing and allow this thrombosed lumen to remain in the patient.
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
Why was a triple lumen PICC inserted? Is there the true clinical need for 3 lumens? For Cathflo to not work is strange. It could be the fact that the tPA did not reach all of the solid intraluminal thrombus. There could easily be intravascular thrombosis around the tip. What you instill - either flush or lock solution or tPA will not reach what is inside the vein around the catheter. Where is the documented tip location? If it is not at the cavaatrial junction, now you have 2 risk factors for vein thrombosis - large catheter size and suboptimal tip location. I can not recall any evidence indicating that a thrombosed lumen increases the risk of CRBSI. But you know that thrombus will also have biofilm. If pieces of that thrombus breaks off it will move into the bloodstream where it can cause CRBSI. After a complete patient evaluation of their needs, risk factors, length of therapy, etc, I would determine the best avenue which would include one of these:
1. remove this catheter and insert a single or dual lumen PICC if that will meet the patient needs.
2. perform a catheter exchange through one of the patent lumens, replacing with a single or dual.
It do not think it is acceptable to do nothing and allow this thrombosed lumen to remain in the patient.
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
Why was a triple lumen PICC inserted? Is there the true clinical need for 3 lumens? For Cathflo to not work is strange. It could be the fact that the tPA did not reach all of the solid intraluminal thrombus. There could easily be intravascular thrombosis around the tip. What you instill - either flush or lock solution or tPA will not reach what is inside the vein around the catheter. Where is the documented tip location? If it is not at the cavaatrial junction, now you have 2 risk factors for vein thrombosis - large catheter size and suboptimal tip location. I can not recall any evidence indicating that a thrombosed lumen increases the risk of CRBSI. But you know that thrombus will also have biofilm. If pieces of that thrombus breaks off it will move into the bloodstream where it can cause CRBSI. After a complete patient evaluation of their needs, risk factors, length of therapy, etc, I would determine the best avenue which would include one of these:
1. remove this catheter and insert a single or dual lumen PICC if that will meet the patient needs.
2. perform a catheter exchange through one of the patent lumens, replacing with a single or dual.
It do not think it is acceptable to do nothing and allow this thrombosed lumen to remain in the patient.
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
Sorry, my computer is doing strange things this morning. I did not post this 3 times but it did take a long time to post. 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
Our general rule is…two attempted with tPa using a vacuum technique in instill allowing maximum time to dwell. If two attempts fail…then the strong possibility is that we are dealing with a precipitant and not an intra-luminal thrombsis