Well, you are exactly right about stating opinion. That is why
statements put forward as "standards" but lacking evidence are just that
- only opinions. And we are ALL entitled to our opinions. . .
And remember, even the Founding Fathers were all criticized for their
"inflammatory" words and actions. Messages are only labeled inflammatory
if you don't agree with them. What is inflammatory to one may be
completely neutral to someone else. Another matter of opinion! Do you
find Tim's comments inflammatory? I do not and therefore will object to
any efforts to censor him (or anyone else who has something to say).
We need a better forum for productive disagreement in order to move the
standards issue forward.
Marilyn Hanchett RN
-----Original Message-----
From: Lynn Hadaway [mailto:[EMAIL PROTECTED]
Sent: Friday, June 09, 2006 3:42 PM
To: Marilyn Hanchett; Brenda Seaver; Tim Talbert; Donna Fritz; Ann
Williams; ann marie parry; IV Listserv; vascular
Subject: RE: Blood Returns,INS standards
It is obvious to me that you and I are talking to vastly different
professional experts because the majority of the ones I talk with do
support the standards. I think we also must recognize that there are
experts in infusion therapy and experts in vascular access. There are
areas where the expert knowledge overlaps but knowledge of vascular
access alone does not make one an expert in infusion therapy. A great
example is the interventional radiologist who are great experts at
inserting catheters but have little to no knowledge of all the infusion
therapy techniques, technology, practices etc that are required to
safely administer the huge number of drugs and fluids through those
catheters.
All nurses are entitled to make any statements they wish to make as Tim
has done, but I do think we have the responsibility to include that one
is stating their opinion. I also think that current thinking can be
challenged in a way that is less inflammatory.
I was a member of the recent committee that revised the INS standards,
so yes I am biased in defense of our hard work. So let this serve as my
disclosure to everyone. Lynn
At 2:54 PM -0400 6/9/06, Marilyn Hanchett wrote:
And how I wonder, Lynn, do you support such a sweeping claim? Most of
the vascular access professionals I know think that the INS Standards
are at best, very weak. Other descriptors are far more derogatory and I
will not repeat them here.
The difference seems to be is that Tim is willing to make a public
statement AND offer a reasonable and clinically appropriate
alternative.
Rather than trying to correct or reprimand him, we should congratulate
him on his willingness to challenge current thinking in the advancement
of science and the improvement of patient care.
In your role with INS you are not, after all, unbiased when it comes to
"defending" the content & quality of this document.
Marilyn Hanchett RN
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway
Sent: Friday, June 09, 2006 1:21 PM
To: Brenda Seaver; Tim Talbert; Donna Fritz; Ann Williams; ann marie
parry; IV Listserv; vascular
>Subject: RE: Blood Returns,INS standards
Tim is expressing his opinion and what he chooses with regard to the
INS standards, however that is not the case with most nurses,
healthcare facilities, etc. in the US. Lynn
At 9:02 AM -0400 6/9/06, Brenda Seaver wrote:
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
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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, 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
