Re: Unblocking CVADs

[Gwen Irwin]

1.  We use the ONS guidelines for clearance of precipitants.  However, we usually try tPA first, in case it is an occlusion of blood.  We have not had to use both ethanol and HCl. 3.  We don't order chest xrays for occlusions.  Our thinking is that the line will be visible in the correct position, and not have any indication of occlusions for blood.  Are you doing xrays to see precipitations??  Interesting concept.  What is seen on those xrays? 4.  If we have a partial withdrawal occlusion, we don't do a dye study of the catheter first.  Criteria is no blood return, but flushes easily.  We then use tPA.  If no results of that, there may be a dye study, before determining the next step. Gwen Irwin Austin, Texas ----- Original Message ----- From: DS BROADHURST To: [EMAIL PROTECTED] ; [EMAIL PROTECTED] Sent: Thursday, November 10, 2005 3:50 PM Subject: Unblocking CVADs As our team is in the process of developing a policy for restoration of CVAD patency, we would appreciate some input from the group (any references for the responses would be much appreciated): 1. Unblocking  AA+ lipid precipitation: Which agent do you instill first (Ethanol or HCl)? If unsuccessful do you then instill a second clearance agent? Is there any evidence out there for or against this- are there incompatiblitiy issues? (I've seen suggestions that the catheter should be rinsed in between each of these instillations; however if the catheter is completely occluded, this isn't possible.) Are these agents compatible with Alteplase, if this was the first agent used? 2. We do not currently use sodium hydroxide for hi pH drugs. Are you using it & if so, with good success? 3. Do you routinely order chest xray prior to each incident of occlusion? If not, do you have a cut-off (i.e., after 3rd incident of thrombotic occlusion xray is required)? 4. Prior to Alteplase infusion for suspected fibrin sheath, do you require a catheter-o-gram?   Many thanks, Daphne Broadhurst