You have raised many of the questions that do not yet have
complete answers. There are so many things that can cause no blood
return such as intraluminal blood reflux from flushing techniques,
complete or partial fibrin sheath, fibrin tail or flap, catheter
rupture, improperly connecting a catheter an implanted port body
causing it to become dislodged, improperly accessing an implanted
port, pinch-off syndrome from subclavian insertions, drug precipitate,
catheter tip position in relation to the vein wall, etc. I am sure
there are others that I have not thought of. As you can see, the risk
is probably different for each type of catheter, e.g., implanted ports
have risk factors that others do not.
Instilling tPA will only reach what is in the catheter lumen and
what is at the immediate catheter tip but it will not reach what is
along the external sides of the catheter. Only a low dose tPA infusion
will get to that area. Instilling tPA and clearing the catheter tip
may allow a dose to be infused but in a month when the patient returns
for more chemo, the fibrin has re-grown from the untouched portion
along the external wall.
Genentech has some resources that may help with this decision.
You may wish to try tPA first, then do a dye study if this is not
effective. Extravasation of vesicants is commonly thought to have the
worst outcomes but infiltration of nonvesicants can also lead to
serious outcomes. Your documentation should indicate that you have
obtained a frank positive brisk blood return and not just a slight
pink tinge of fluid.
As you can see there are many questions yet to be answered. We
need more research! Lynn
At 9:22 PM -0400 6/9/06, [EMAIL PROTECTED] wrote:
I'm sorry if I've opened a can of worms here, although I must admit I have enjoyed your debate. I learn so much from all of you. I realize that every patient/ therapy must be assessed individually but in developing a good policy that the nurses can feel comfortable with and we can stand on I have a few more questions.
1) How freq do dye studies need to be repeated?
2) if no blood return, no response to tpa, dye studies indicate no mechanical defect,or mal position.Woud you infuse with signed MD order and dye report. ( non vesicants)
3) When documenting blood return how specific do we need to be? Is "positive blood" enough?
Brenda
--
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
