Re: Unblocking CVADs

[Patricia Luptak]

I have created a booklet addressing all of these issues including a policy, a competency as well as a chance to earn 1 contact hour from ONS. This booklet is available by contacting the LITE office at www.lite.org. Our secretary will be glad to send you as many as you need. This project was sponsored by Genentech. I will be publishing again soon on the evidence based outcomes on dripping 2mg of Cathflo in 50cc of  d5w or nss. This is very successful for persistent withdrawal occlusions, or sluggish CVADS or dialysis catheters.  In case you are not familiar with LITE it is the first IV education organization founded in 1972 here in Pittsburgh. It stands for the League of Intravenous Therapy Education.

Thanks

Patty Luptak

LITE Presidential Advisor

DS BROADHURST <[EMAIL PROTECTED]> wrote:

Gwen, Thank-you for your reply. I don't have the ONS guidelines & will look them up. The CXR is ordered for recurrent occlusions, to rule out tip migration.

Gwen Irwin <[EMAIL PROTECTED]> wrote:

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

Patty

 

Patty Luptak RN OCN BSEd 

Manager Oncology/Infusion Services @ Jefferson Regional Medical Center 
LITE Presidential Advisor
www.lite.org

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