Please see my answers belowin CAPS. These are just MY opinions...
Nadine Nakazawa, RN
PICC Program Coordinator, Stanford Hospital
From: [EMAIL PROTECTED]
Subject: Re: Blood Returns,INS standards
Date: Fri, 9 Jun 2006
1) How freq do dye studies need to be repeated?
A. IN MY EXPERIENCE, RARELY. THE MOST LIKELY CAUSE OF LACK OF BLOOD
RETURN IS A BIT OF THROMBUS OR FIBRIN AROUND THE TIP OF THE CATHETER. AFTER
ATTEMPTING TO GENTLY RESTORE PATENCY WITH A NS FILLED SYRINGE USING A GENTLE
PUSH-PULL TECHNIQUE, THEN I WOULD GET AN ORDER FOR ALTEPLASE (CATHFLO) AND
GENTLY INSTILL THE ENTIRE AMOUNT. IT IS EXTREMELY IMPORTANT TO OVERFILL THE
CATHETER LUMEN AND 2 MLS WILL OVERFILL MOST CATHETERS EXCEPT CERTAIN
DIALYSIS CATHETERS.
DO THE FIRST BLOOD CHECK AT 30 MINUTES, AND LEAVE IT IN IF THERE IS NO BLOOD
RETURN. CHECK EVERY 30 MINUTES UNTIL YOU GET BLOOD RETURN. IF NO RESULTS
AFTER 2 HOURS, REPEAT THE DOSE.
IF THERE IS STILL NO PATENCY AFTER TWO DOSES (AND 4 HOURS), THEN I RECOMMEND
A DYE STUDY TO RULE OUT TIP MALPOSITION.
THE REASON FOR THE ABOVE SEQUENCE OF STEPS IS BECAUSE FIBRIN OR CLOT IS THE
MOST LIKELY CAUSE OF LACK OF BLOOD RETURN, AND THEN RULING OUT TIP
MALPOSITION IS RELATIVELY EASY TO DO WITH A CXR AND IS LESS INVASIVE.
IF THE CXR IS NEGATIVE, THEN A DYE STUDY WOULD BE WARRANTED. BUT THIS
SHOULD BE RELATIVELY UNCOMMON (AT LEAST IN MY EXPERIENCE).
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)
A. YES, IF THE DYE STUDY INDICATED GOOD TIP POSITION, MEANING THE TIP IS AT
THE CAVAL-ATRIAL JUNCTION OR IN THE DISTAL SVC.
3) When documenting blood return how specific do we need to be? Is
"positive blood" enough?
A. I JUST SAY "BLOOD RETURN OBSTAINED", BUT PERHAPS THE LEGAL EAGLES WILL
HAVE BETTER VERBIAGE THAN I CAN SUGGEST.
NADINE NAKAZAWA
Brenda
