On traditional syringes, there is a rubber-like gasket at the
bottom of the plunger rod. When you empty the syringe by flushing all
the fluid into the patient, this gasket is compressed. Force on the
plunger rod is usually released as you disconnect the syringe from the
injection site, causing the gasket to expand and to pull blood back
into the catheter lumen. There are prefilled syringes designed to
prevent this problem with catheter flushes. The amount of positive
displacement from a positive injection system may or may not be enough
to overcome the syringe reflux and the disconnect reflux. My bet would
be that none of them have enough fluid displacement to overcome the
reflux from both causes. The catheter, needleless connector and
syringe must be regarded as a system. Changing only one piece may not
be sufficient to prevent problems with occlusion. Lynn
At 12:46 PM -0500 4/24/06, Ann Williams wrote:
Lynn could you educate me on the syringe component? We use the BD 10ml luer-lok and was not aware that the syringe could be a problem.
Maybe I am the only one has been in the dark on this, but will be interested in your response.
Thanks!!
ann
Ann Williams RN CRNI
Infusion Specialist
Deaconess Home Services
600 Mary St.
Evansville, IN 47747
812-450-3828
812-450-4665 FAX
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway
Sent: Monday, April 24, 2006 10:12 AM
To: Lorraine Campbell; [EMAIL PROTECTED]
Subject: Re: Tpa
The half life of tPA is very short - less than 5 mins - so there should be no clinical problem. Your problem will be financial. Why continue to use a product that is increasing your cost of providing care? tPA and the nursing time to do the procedure is not cheap! I would investigate the flushing techniques being used - no positive pressure flushing technique with a positive displacement device. Also what syringe are you using? There is blood reflux from 2 sources - the syringe and the process of disconnecting from the catheter hub. The positive displacement from the positive cap is probably not enough to overcome the reflux from both of these. If you are not using a syringe that has been redesigned to prevent this problem, I would suggest that you teach them to not inject all the fluid from the syringe because it is compression of the plunger rod tip that causes the reflex. Lynn
At 8:23 PM -0400 4/23/06, Lorraine Campbell wrote:Is there a limit to how many times Tpa may be used to open a blocked PICC line (or any other CVC for that matter)?Since switching to Saline only flushes in our acute care facility a short while ago, we have seen a great increase in blocked lines --we do use a positive pressure cap but the staff does not always use it correctly. We are continuing to emphasize correct flushing protocol BUT in the meantime, is it contraindicated to use Tpa to open a blocked line more than once in a short time( within 24 to 48 hours)?Lori Campbell CRNIAvoca, PA
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
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Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
