What a catch 24 this is
Having a policy to remove clamps from a non valved catheter is not the best
options from a legal standpoint. The clamp is on the catheter due to the risk
of air embolism and bleed out in a open ended central line during cap and
tubing changes. Now I know with PICC lines that risk is almost zero but from a
patient safety risk the clamp must be added to all open ended central lines.
Taking the clamp off as in the case of the Arrow being removable can put the
facility at risk. Nurses are told to clamp or pinch the tubing during tubing
and cap changes however there would be no clamp to close. Although the risk is
low that is why the clamps are there. It is part of the design for market
approval due to patient safety risk.
I understand your frustration in the education of teaching the nurses to
unclamp the lines after the caps are in place or tubing.
Good luck on the education piece.
kathy
________________________________
From: [EMAIL PROTECTED] on behalf of [EMAIL PROTECTED]
Sent: Sat 2/25/2006 3:43 PM
To: Nicastro, Margaret
Cc: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Nuetral injection cap
We have used the CLC for 4 years--At first because that is the product Arrow
supplied in their insertion kit--Then it went system wide because we wanted to
be "Saline Only" but there have always been issues which have exponentially
escalated recently due to PICC brand change and also a greater amount of CLC
product in use by more newly hired inexperienced nurses--I believe both Cook
and Arrow include CLCs in their Triple Lumen trays and we placed CLCs on all
1000 PICCs we inserted this past year--Prior to Jan 2006 we used the Arrow PICC
products and the "clamps" were easily removed--Now that we are using BARD
products in order to remove the clamps the nurse would have to "cut" them
off--If nurses are unaware of the very distinct flushing method for positive
displacement valve technology withdrawl occlusion can result within hours of
insertion necessitating tpa for restoration of catheter function--Also there
seems to be a spike in infection related issues particularly in the!
ICU--They have resorted to changing CLCs every day on every lumen of every
CVC--Pretty dramatic reaction and very costly as well--Out on the floor the
Vascular Access RN manages the after care for all CVCs--We too find issues
daily that require interventions--I think we are quicker to use tpa (the nurses
call us when they can not obtain blood return for lab sampling) and we have
been known to "disable" the clamps if we have too--We are constantly explaining
and reexplaining the differences between "valves" and "caps"--We are
encouraging independent critical thinking but are vexed by the lack of
enthusiasm for all things infusion related--We like the idea that this nuetral
injection cap would seemingly eliminate these frustrations
--
Robbin K. George RN
Vascular Access Resource
Alexandria Hospital Virginia
-------------- Original message --------------
From: "Nicastro, Margaret" <[EMAIL PROTECTED]>
> Robbin,
>
> I am curious as to what problems your ICU has encountered with the
CLC. We have
> been using this device for about 8 years on all central lines in our
institution
> and have not had problems.
> I am interested in hearing your problems.
>
> Margaret
> Margaret M Nicastro, CRNI, OCN
> Coorordinator IV Therapy/Oncology
> Gettysburg Hospital
> 147 Gettys Street
> Gettysburg, PA 17325
> Phone: 717-337-4312
> Fax: 717-337-4485
>
>
> ________________________________
>
> From: [EMAIL PROTECTED] on behalf of
> Sent: Tue 2/21/2006 10:54 PM
> To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
> Subject: Nuetral injection cap
>
>
> Have been reviewing some old emails I copied for personal archive--In
early
> December Martha Pike wrote a lengthy and glowing evaluation of the
Rymed
> Invision-Plus Nuetral injection cap--If she could please give us an
update and
> allow us to use her comments for benchmarking purposes we would be
most
> greatful--We are having tremendous issues with the CLC in our ICU and
would like
> to recommend a change--I have visited the Web site and received an
information
> packet from the company but could use some first hand professional
support and
> end user input--Anyone else out there using this product please
contribute your
> thoughts to the thread--Thanks to everyone in advance
>
> --
> Robbin K. George RN
> Vascular Access Resource
> Alexandria Hospital Virginia
>
>
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