We had a peds patient come to ER with an implanted port that was occluded. Where can we find out the volume of the port lumen to determine the dose of tPa or Cathflo to administer to declot? Are all peds prt standard sized? What size are peds ports?
We had a peds patient come to ER with an implanted port that was occluded. Where can we find out the volume of the port lumen to determine the dose of tPa or Cathflo to administer to declot? Are all peds prt standard sized? What size are peds ports?
Does the patient/parents have the patient information card that comes in all VAD kits? You should find this information on that card. If that card does not have that information or no card is available, you could use an empty syringe, withdraw blood until it reaches the male luer tip of the syringe, then use the empty space in the syringe as the internal volume for the catheter. Even if you have the brand or manufacturer, there are different sizes of the port and catheter for peds, just like there are for adults. Also, the catheter length has probably been cut to the patient specific length and this will alter internal volume as well. For a totally occluded catheter without a blood return, this would only be a guess based on size of the patient, but you would still have to know the brand or at least the manufacturer of the port to get some information about what the catheters internal volume was when it came from the package. 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
The patient's parents did not have a information card or even seem to know what we were talking about. Line was totally occluded from other hospital a distance away. Could a 2mg dose have been safely administered to declot the port?
How old was the child? What was the primary and secondary diagnoses? What other risk factors? Did you have an xray to determine tip location and any potential tip migration? What led up to the problem? In other words have you ruled out other causes of obstruction such as mechanical or precipitate? What instructions are included in the CathFlo information about such situations/ I can't tell you what dose to use without a thorough assessment of the situation. I am not surprised that the parents did not have the card. The inserter may never have given it to them. 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
As I was not the nurse who cared for the peds patient, I do not know the answer to all these questions. I was asked after the fact the best way to have handled the situation. It does make me realize the importance of staff doing a thorough assessment of the lines and situation. Thanks!
Implanted ports can be very difficult to declot, especially in pediatrics due to the smaller french sizes. Common port sizes in pediatric patients include 5 FR SL, 6.6. FR SL, and 10 FR DL. If the patient/parent is unsure of the port size/manufacturer, we will call the hospital where the port was placed and try to find out this information. Our Vascular Access Team have laminated cards with catheter sizes/manufacturers and priming volumes, this information may be located on the manufacturer webpage, insertion trays, or by contacting the manufacturer directly.
As Lynn mentioned, it is important to obtain a thorough history of the events leading up to the occlusion (infusates, flushing schedule, possibility of a precipitate, complication history). The port may be reaccessed to ensure proper placement.
Priming volumes of common port sizes include:
5 FR 0.8mL
6.6 FR 1.2mL
10 FR DL 1.8mL
CathFlo Dosing:
For patients > 30kg, instill 2mg/2mL of Cathflo
For patients < 30kg, instill 110% of the catheter priming volume (it is also important to add the priming volume of the port access needle/extension tubing, approx. 0.2mL)
-A 2nd dose of Cathflo is instilled if the port remains occluded after 2 hours
-For total occlusions, a 3-way stopcock or single syringe may be used to instill the Cathflo
-An early sign of a thrombotic catheter dysfunction is a sluggish port, we proactively treat ports once they become sluggish or have a partial occlusion.
Darcy Doellman RN, BSN, CRNI, VA-BC
Vascular Access Nurse
Cincinnati Childrens Hospital