I am seeking input on a problematic port-a-cath. A pt has had an existing port for 6years. Over the past 1/2 year this port has had much diffiulty aspirating blood. After a dose of TPA it works great, but within 4-5 days it experiences problems again with aspirating blood. I have discussed the need for vigorous flushing, but is still problematic. It is accessed and heparinized q month when not in use. She is not a candidate for a new port because of limited sites. Any suggestion on how to differently manage this port. Should they access weekly to heparinize or bi-monthly?
Anything you do through the catheter lumen is not reaching what is happening in the vein around the catheter tip. When you instill tPA, the overspill from the tip of the catheter reaches a small amount of the fibrin/thrombus that forms around the catheter tip. Then over the next few days/weeks, the fibrin/thrombus regrows and occludes the lumen again. There is quiet likely a long coating of fibrin/thrombus along the entire catheter length. Removing the entire length of fibrin/thrombus would buy you more time with this implanted port. You can accomplish this with an infusion of tPA, usually adult dose is 50 mg diluted and infused over 3 or 4 hours. There are several protocols for this and it is published in the literature. This would clear the catheter enough to give you a much longer time with a blood return. But the fibrin/thrombus will form again in time because this is the human body's natural process for protecting the bloodstream from the foreign object of the catheter. I noticed that you are from a childrens hospital and I don't remember if this tPA infusion has been used in children. If there are any other signs or symptoms of complications (fever, pain, discomfort, edema, etc) with this implanted port I would find a way to remove it as 6 years is a rather long time for this catheter to dwell. Interventional radiologist can insert from the translumbar, transhepatic, or femoral veins with the port body tunneled to usually the iliac crest. 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
Thank you for the input. To my knowledge this is not done at Children's for this reason, but will check with our pharmacy.
Denise
I work at a children's hospital and we do tPA infusions for fibrin sheaths. This is the dosing we use:
CENTRAL VENOUS CATHETER THROMBUS OR FIBRIN SHEATH - 0.02 mg/kg/hr IV infusion over 12 hours. Maximum dose 2 mg/hr. We also restrict the administration to RNs who have completed our critical care training or are chemotherapy certified. The dose is so low, though, that we have never seen complications.
Feel free to contact me if you would like more information. [email protected]