Tim, What do you mean by this? Brenda -----Original Message----- From: Tim Talbert [mailto:[EMAIL PROTECTED] Sent: Thursday, June 08, 2006 7:29 PM To: Donna Fritz; Ann Williams; ann marie parry; IV Listserv; Brenda Seaver; vascular Subject: RE: fill volumes, Blood Returns
The INS "Standard" is obviously wrong, which is why it is ignored. Tim >>> "Fritz, Donna" <[EMAIL PROTECTED]> 6/8/06 >>> Since you mention oncology nurses and their seemingly cavalier attitude about blood return, comments from ONS on blood return from CVCs do not seem to be as strong as INS statements, interestingly. Our own policy is that we need to have blood return or we need a good explanation as to why we don't (x-ray confirmation of a kink, etc) >From Access Device Guidelines (2nd ed) from ONS: "No studies to date have provided a research-based answer to when to give medications through a device without a blood return. 1. It is generally recommended in various clinical settings that prior to administering medications through VADs, in which no blood return exists, placement verification should be accomplished either through x-ray or dye studies. Peripheral and midline catheters should be reinserted if there is no blood return. 2. Administration of vesicants should be prohibited unless catheter tip placement, catheter body intactness, and catheter patency are determined. If the catheter tip is determined to have a fibrin sheath or clot resulting in backflow, vesicants should not be administered. Backtracking of a vesicant can result in extravasation. A physician order should be obtained to use a VAD when there is no blood return if the VAD is determined to be intact, in correct position, and patent." p. 99 INS standard # 45 on implanted ports: C. ". . . In the absence of a positive blood return, infusion therapy should be withheld until the problem can be diagnosed and treated." p. S46 INS standard # 42 on catheter placement: N. "If the patient is receiving long-term or chronic therapies, repeat radiographic study should be performed to confirm catheter tip location, according to organizational policies and procedures." p. S43 ________________________________ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Brenda Seaver Sent: Thursday, June 08, 2006 2:05 PM To: Ann Williams; ann marie parry; Listserv, IV; vascular Subject: RE: fill volumes, Blood Returns Thank you Ann for your response. We are privately owned, no hospital affiliation. We have a hard time convincing case managers and discharge planners that this is important for us to have before admission. As far as the Oncology nurses, It surprises me that They are not concerned. We hook up the 5FU, but they're giving the "Big Boys" there. They joke in front of the patients about how particular we are. Isn't that a GOOD thing when it comes to patient care? I don't get it. We don't want to loose this account, but patient safety has to come first. Do you or anyone out there have a policy I could look at? Thank You so much Brenda -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Ann Williams Sent: Thursday, June 08, 2006 3:29 PM To: Brenda Seaver; ann marie parry; Listserv, IV; vascular Subject: RE: fill volumes, Blood Returns Yes, Brenda, we do require a tip placement verification before we begin therapy. We are fortunate in that most of ours come from our "mother" hospital and I can view the results in the computer. Our referral nurses are good about copying the report from the chart when they are gathering the chart parts. Your beginning statement sounded like it was written by me! (The 5-FU patients). But I haven't heard any problems from our nurses. So either there is no problem, or they are ignoring it, in which case I will have to hunt them down and hurt them!! :) I think, like you, I would also want to see the report. If I can be of any help, let me know. 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 Brenda Seaver Sent: Thursday, June 08, 2006 11:25 AM To: Brenda Seaver; ann marie parry; Listserv, IV; vascular Subject: RE: fill volumes, Blood Returns -----Original Message----- From: Brenda Seaver [mailto:[EMAIL PROTECTED] Sent: Thursday, June 08, 2006 11:47 AM To: ann marie parry; Listserv, IV; vascular Subject: RE: fill volumes, Blood Returns I was wondering if anyone has a policy they would be willing to share on validating line placement or usability. We are a home infusion company. We have many patients that we hookup to 5FU via a CADD prizm for 48 hour continuous infusion at an Oncology suite after their chemo there. These patients all have accessed ports when we get there. Our nurses flush, check for patency, and hooks up pump, then we see patients 2 days later for disconnect and deaccess. Problem is we're finding many patients don't have a blood return when we go to hookup. We have been told there OK to use by MD, they flush easily, some say studies have been done -but we have no report to back that up. We are seen as a nuisance when we push for studies. We don't want to take chances with our patients like this. Lately we have been reaccessing (which of course the patient hates-another stick), then we tpa, Chemo hookup is delayed and everyone is upset. One patient still had no blood return, we were told studies were done, ports OK, unable to find report? What do we do? Our Nurse Educator and myself have scheduled a meeting with the office manager, I want to go in there with a good policy. Please help; I learn so much from all of you. One more question, when a new patient comes on service With Central line do you all require placement reports before infusing? Again we are home infusion. Thank you so much Brenda -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of ann marie parry Sent: Wednesday, June 07, 2006 9:25 AM To: Listserv, IV; vascular Subject: fill volumes Our hospital is considering trialing Ethanol locks - there is a debate about the fill volume to use - will be used in PICCs, tunneled and non-tunneled lines as well as some dialysis catheters. They want to keep it standardized as much as possible for adults. They will also be using it in the peds population. I have done some limited research but I would like to hear what others have to say. Thanks Ann Marie ----- Original Message ----- From: Heather Nichols <mailto:[EMAIL PROTECTED]> To: Listserv, IV <mailto:[EMAIL PROTECTED]> ; Peng, Kathleen <mailto:[EMAIL PROTECTED]> Sent: Wednesday, May 24, 2006 1:16 PM Subject: Re: FW: Need article references Kathleen, We just put a policy into effect on your number one question. We evaluate tip location on any line that comes in house for use. It does not matter what type of line it is. We had an issue just last week where a man came in for chemo and said he had a PICC. It was barely a mid-line, and the man was to get Vinchristine What a disaster that could have been. Our policy also reads that a central line of any kind must have a good blood return and flush easily. If not, we can tPA, by either stop cock for solid occlusion, or drip for no blood return. If the tPA does not work, the patient is to go for a dye study in IR to find out what is wrong with the line. IR, and the primary team has final say. We use stop cock to avoid putting too much pressure on the line, and the ability to agitate the clot slowly. Hope all is going well with you guys! Heather Nichols RN BSN CRNI Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Peng, Kathleen" <[EMAIL PROTECTED]> 5/24/2006 11:56 AM >>> ________________________________ From: Peng, Kathleen Sent: Wednesday, May 24, 2006 10:53 AM To: IV Listserv; '[EMAIL PROTECTED]' Subject: Need article references I was just asked by one of our educators for some input on two of our policies that are being worked on: 1). Central Line Care: need for initial CXR on a pt that is admitted with a CVL already in place (PICC, Jugular, Subclavian) Currently, it is not actually in our policies that a CXR NEEDS to be done prior to use but we have educated staff on the need in the case of PICCs. What is everyone else doing and what are your references to support your practice? 2). Obstructed Catheters/Use of TPA Currently our policy just basically states to use TPA 2 mg, let dwell, etc. The question is whether to use the stopcock method or hook the syringe directly to to the lumen. We have been instructing to just hook the syringe to the lumen and it has been working well. What are others doing? Are there references out there to support one practice over another? Thanks, Kathleen Witt, RN, BSN Nutrition Support Presbyterian Hospital of Dallas 214-345-7468 [EMAIL PROTECTED] The information contained in this message and any attachments is intended only for the use of the individual or entity to which it is addressed, and may contain information that is PRIVILEGED, CONFIDENTIAL, and exempt from disclosure under applicable law. If you are not the intended recipient, you are prohibited from copying, distributing, or using the information. 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