I have been approached by our Pharmacy Director about my volume of cathflo useage. It seems that in our division our hospital ( 101 bed, I am only PICC nurse) has a significantly higher useage of Cathflo and that seems to be a red flag to them. I have discussed at length with the Pharmacist Director the indications for the administration of Cathflo as well as the rationale of why I cant just ignore or delay the proper treatment of an line occllusion.
I need input from you if you have had issues with this and what your resolution was.
I am saying to them first and foremost that I will not stop my current practice of administering Cathflo when it is indicated for my patients with line occlusions. They want to know if there is something we can /floor nurses can do differently to avoid or reduce line occlusions.
1. We use the Bard solo Power PICC ( been using for years and years) that only requires flushing before and after each use or once a week if not used. ( I use neutral displacement caps) The pharmacisits are wondering if they had the nurses flush the lines every 12 hours if this would help, or .....if they had the nurses to scan the barcode of saline flush evertime it is used to be sure they are flushing properly. I shared with them how I teach and preach on proper flushing of lines, as well as timely dissconections for infusion pumps upon completion of meds. How more flusing and line manipulation is not always a good thing as well as manufacturers recommendations on flushing.
2. I shared with them that this is a common occurence with central lines in patients and must be treated wehen it occurs and not left to sit or ignore.
3. I think the key thing here is that many other facilities that I am being compared to do not have a person dedicated to not only inserting the PICC lines but doing the daily care and maintenece of the line. When someone takes ownership of the process it is handled differently than when the floor staff is responsible for care and maintenance. I stressed that many times the staff my just use the other more patent lumens and not deal with the occlusion, how if the occlusions are left untreated they can extend to other lumens as well as increase risk for infection. I have talked to some facilities that the nurses /picc nurse doesnt even use Cathflo ( seems an education/comfort level issue)
4. I do not think we have an excessive use of Cathflo or line occlusions with my pt population. I have an average pt load of 15-25 pts who have picc lines in daily that I monitor and may have to give cathflo to 1-3 patients every 3 days or so. I also do Cathflo treatment to Ports or physician inserted central lines when needed. In the past I have done the numbers and stats and % of occlusions was in the low "teens" ( if my memory serves me right) . I will have to do another data collection on that.
Thanks in advance, Gina Ward R.N.
Wow Gina, I would say you have that well covered. I agree that with a dedicated person who knows how to manage CVADs the usage would go up. At my hospital, before I came they just replaced the line when it was occluded. IR put in DL in case “one becomes occluded”. All that madness stopped and yes cathflo usage went up.
We used the solo too but I have since changed to an open ended PICC with a neutral cap. Cathflo usage dropped. Anytime a valved PICC comes in to the organization nurses think it’s occluded because there is a technique to getting the valve open. Think about the part time nurse that really only touches a valved PICC once every few months, first they are not comfortable with PICC let alone understand how valve works.
There are 2 antithrombogenic PICCs on the market. I would like to do a formal study on one or both to see if we could decrease occlusions even father. The literature suggests that where there is a thrombus formation there is infection.
Continue to treat the occlusions, it is the right thing to do. I would consider looking into other technology to improve patient outcomes. One product does not meet all our patients needs.
I too would say that your occlusions are frequent, but I also know that that is common with the Solo Power PICC and its "sister" the non-valved Power PICC. Out of all of the IV catheters which I get called out to declot, 99.9 % of them are either the SOLO or the POWER PICC. Why do they occlude so frequently (tensile strength, Catheter material, size) not sure, but I do know that unless it is condraindicated, I encourage orders for 10U/ml Heparin Flush solutions in all Power PICC's, yes even the valved ones as they are still open ended at their tip where the fibrin builds up.
We only place Groshongs (Midline and PICC's) and rarely do I get an occlusion call for them.
Hi Gina,
I too am the lone PICC nurse at our 120 bed rural hospital. BARD open-ended power PICCs are used here with Microclave neutral caps. Approximately 220-260 PICCs are placed each year with between 50-60 declots annually. We flush q 12 hours with saline and before/after meds and blood draws with in-patients; our out-patients use saline followed by low dose Heparin. Our facility got away from using Heparin several years ago with the HIT scare.
We seem to be seeing a trend of increased use of Cathflo in our patients on Zosyn with its slow administration rate....?????
Best wishes to you, Gina.
Cindy Harrison BSN, RN, VA-BC
Gallipolis, OH