1. Double your efforts with training on proper flushing technique to reduce the problem of intraluminal thrombosis.
2. When you can not aspirate blood from any CVAD, not just a PICC, you can a) confirm tip location with a regular chest xray, 2) perform a contrast injection under fluoroscopy to determine the fluid pathway and rule out retrograde infusion and confirm intravenous tip location, 3) work with a pharmacy that will aliquot another thrombolytic drug such as urokinase. Prior to 1999, urokinase was the first choice for thrombolytics to clear a catheter. Many problems, challenges, and remedies later, urokinase is no longer on the market in a small dose with a labeled indication for catheter clearance. Retaplase is another drug that has been used. Both of these have studies on their use for this purpose. You will need to work with your phamacy as they will need to reconstitute a large dose vial, aliquot into syringes and freeze. You get the frozen product to thaw and use. Lynn
We have been teaching proper flushing, use heparin and trying to eliminate all unnecessary blood draws. The line placement is good. Even though it flushes easily, do I still have to use a clotting agent? Can I just declot the one port?
Your did not mention anything about checking for a blood return. Along with flushing without resistance, a blood return is a strong component of patency assessment and is included in both INS and ONS standards. By line placement being good, I am assuming your mean that the tip is location at the cavoatrial junction. Many times radiology will use this "good position" phrase but that really does not tell you any comfirmation that the tip is in the correct location. Correct to some radiologist is not the same as correct to us. For a multiple lumen catheter, I would want to see no flushing resistance and a good blood return from all lumens. I would only use the lumens where this was the case, so the declotting procedure may be needed. Lynn
Before Cathflo our pharmacy would alloquot tpa left over from procedures. See if they can help you with this solution. Just make sure they put in 10ml syringes.
1. Double your efforts with training on proper flushing technique to reduce the problem of intraluminal thrombosis.
2. When you can not aspirate blood from any CVAD, not just a PICC, you can a) confirm tip location with a regular chest xray, 2) perform a contrast injection under fluoroscopy to determine the fluid pathway and rule out retrograde infusion and confirm intravenous tip location, 3) work with a pharmacy that will aliquot another thrombolytic drug such as urokinase. Prior to 1999, urokinase was the first choice for thrombolytics to clear a catheter. Many problems, challenges, and remedies later, urokinase is no longer on the market in a small dose with a labeled indication for catheter clearance. Retaplase is another drug that has been used. Both of these have studies on their use for this purpose. You will need to work with your phamacy as they will need to reconstitute a large dose vial, aliquot into syringes and freeze. You get the frozen product to thaw and use. 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
We have been teaching proper flushing, use heparin and trying to eliminate all unnecessary blood draws. The line placement is good. Even though it flushes easily, do I still have to use a clotting agent? Can I just declot the one port?
Regina C. Moran, RN MBA CPHQ
Your did not mention anything about checking for a blood return. Along with flushing without resistance, a blood return is a strong component of patency assessment and is included in both INS and ONS standards. By line placement being good, I am assuming your mean that the tip is location at the cavoatrial junction. Many times radiology will use this "good position" phrase but that really does not tell you any comfirmation that the tip is in the correct location. Correct to some radiologist is not the same as correct to us. For a multiple lumen catheter, I would want to see no flushing resistance and a good blood return from all lumens. I would only use the lumens where this was the case, so the declotting procedure may be needed. 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
Before Cathflo our pharmacy would alloquot tpa left over from procedures. See if they can help you with this solution. Just make sure they put in 10ml syringes.
Good luck,
Darilyn