Kathy is correct when you look at only the short-term or
immediate outcomes. But we have no data on the long-term impact of
this on the patient's future pulmonary health. If someone knows of
this data, I would love to know about it. So the immediate decision
about managing fibrin sheaths would be to minimize the risk to the
patient and do a risk-benefit analysis for each patient, then
carefully choose the best treatment option. Lynn
At 11:46 AM -0600 6/27/06, Kokotis, Kathy wrote:
I want every one to visualize a large bore dialysis catheter (two 10 gauges or one 16 gauge)
I want you to visualize a large fibrin sheath
I want you to visualize a radiologist stripping that sheath with a lasso into the lungs
Now talk to me about PE. They rarely die do they. The lungs are a wonderful thing
Kathy
From: [EMAIL PROTECTED] on behalf of Nadine Nakazawa
Sent: Fri 6/23/2006 12:05 PM
To: [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
Subject: RE: Central lines (femoral)
Tanya: We probably do throw fibrin and clots into the pulmonary circulation every day, just with flushing against a small amount of resistance. However, the body's fibrinolytic system will break down a lot of these small clots/fibrin. It is true that if a large clot is dislodged, then DVTs from central venous catheters are the main source of PEs from the upper extremity. The thinking that rigid wall catheters have larger clots is erroneous. Any type of indwelling catheter can generate a clot. It is not only the catheter, but what is being infused, if the patient is hypercoagulable already, if that catheter tip is impinging against the SVC wall, etc, etc...
It is erroneous to think that one type of catheter is the primary cause of thrombotic catheter complications. It's much more multifactorial than that. it's much more important that the occlusion be diagnosed and treated early in the process rather than waiting, or exchanging that catheter. Catheter exchange IS appropriate if there is any tip malposition, eg, the tip is imbedded in the vein wall, etc.
Nadine Nakazawa, RN, BS, OCN
PICC Program Coordinator
Stanford University Hospital and Clinics
Stanford University Medical Center
From: "Nauman, Tanya" <[EMAIL PROTECTED]>
To: "Nadine Nakazawa" <[EMAIL PROTECTED]>
CC: "Perry, Stephen" <[EMAIL PROTECTED]>,"Crocker, Holly" <[EMAIL PROTECTED]>,"Sessions, Sharon" <[EMAIL PROTECTED]>
Subject: RE: Central lines (femoral)
Date: Fri, 23 Jun 2006 10:51:17 -0700
>Nadine
>Thanks so much for your response. This was an
>OLD policy, never questioned until now(not an
>excuse, I know). I believe the original thinking
>was that acute care central venous catheters were
>too "rigid-walled", and that any instillation would
>cause the clot to be dislodged into the vascular
>system. Perhaps that was true with some of the
>other(or earlier)catheter materials?
> I've just finished reading Arrows Multi-Lumen
>CV catheters Nursing Care and Guidelines--the
>section on Management of Occlusions. With that
>info and all the great responses I've received,
>We hope to get this policy changed very soon.
>Tanya
>
>-----Original Message-----
>From: Nadine Nakazawa [mailto:[EMAIL PROTECTED]
>Sent: Thursday, June 22, 2006 10:27 PM
>To: Nauman, Tanya; [EMAIL PROTECTED];
>[EMAIL PROTECTED]; [EMAIL PROTECTED]
>Cc: Perry, Stephen; Crocker, Holly; Sessions, Sharon
>Subject: RE: Central lines (femoral)
>
>
>What is your concern, Tanya? Cathflo is indicated for catheter clearance
>for any type of central venous catheter. If a triple lumen is occluded,
>what else would you try to do? Exchanging a triple lumen only increases
>the risk of venous thrombosis and stenosis and may increase infectious risk.
> To leave a lumen clotted also increases infectious risk. I WANT the ICU
>/critical care nurses to use Cathflo to declot triple lumens. I want any>nurse to recognize catheter occlusion and problem solve it as they would
>with any type of catheter. It is always best for patients if the occlusion
>is recognized early, and appropriate assessment and management of the
>occlusion occur in a timely manner to prevent undue delays in delivering the
>IV therapy course and preventing further complications.
>
>Cathflo is very safe.
>
>Nadine Nakazawa, RN
>PICC Program Coordinator
>Stanford Hospital & Clinics
>
>
>
>
>
> >From: "Nauman, Tanya" <[EMAIL PROTECTED]>
> >To: "Kokotis, Kathy" <[EMAIL PROTECTED]>, "Wilkinson,
> >Kimberly" <[EMAIL PROTECTED]>, "IV list server"
> ><[EMAIL PROTECTED]>
> >CC: "Perry, Stephen" <[EMAIL PROTECTED]>, "Crocker, Holly"
> ><[EMAIL PROTECTED]>, "Sessions, Sharon"
> ><[EMAIL PROTECTED]>
> >Subject: RE: Central lines (femoral)
> >Date: Wed, 21 Jun 2006 10:06:27 -0700
> >
> >I'm adding this to an existing thread since I can't seem to send a new
> >email and have it appear on the listserve.
> >Are any of you using alteplase(tpa)to declot Arrow central catheters?
> >We have a policy that states alteplase is be used only to declot silastic
> >catheters-not "rigid-wall" catheters.
> >A couple of docs have been really mad when we refused to use it on
> >their pts acute care IJ lines. Are we wrong? Any input appreciated.
> >Tanya RN
> >I.V. Support
> >SHMC
> >Eugene, OR
> >
> >-----Original Message-----
> >From: [EMAIL PROTECTED]
> >[mailto:[EMAIL PROTECTED] Behalf Of Kokotis, Kathy
> >Sent: Monday, June 12, 2006 10:07 PM
> >To: Wilkinson, Kimberly; IV list server
> >Subject: RE: Central lines (femoral)
> >
> >
> >go to www.cdc.gov
> >type in intravascular guidlelines for 2002
> >
> >that has all the info you are looking for
> >kathy
> >
> >
> >
> >
> >
> >Confidentiality Notice: This e-mail and any attachments are intended only
> >for the use of those to whom it is addressed and may contain information
> >that is confidential and prohibited from further disclosure under law. If
> >you have received this e-mail in error, its review, use, retention and/or
> >distribution is strictly prohibited. If you are not the intended recipient,
> >please contact the sender by reply e-mail and destroy all copies of the
> >original message and any attachments.[v1.0]
> >
> > _____
> >
> >
> >
> >From: [EMAIL PROTECTED] on behalf of Wilkinson, Kimberly
> >Sent: Sun 6/11/2006 8:46 AM
> >To: IV list server
> >Subject: Central lines (femoral)
> >
> >
> >
> >Good afternoon, another question for the group.
> >Are there any guidelines or policies for Culturing central lines. (
> >catheter tips and insertion sites?)
> >Any articles guidelines or policies on the length of time a femoral line
> >should be in? infection rate femoral vs other lines
> >
> >Thank you
> >Kim Wilkinson
> >Wilmington DE
> >
> >
> >___________________________________________________________
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> ><< Bard100.jpg >>
>
>
>
>
--
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
