RE: Radiology

[Nancy Moureau]

Title: Message

What do you think of Darcy Doellman's research article in the JPEN that showed reduced infection rate with lines flushed with heparin vs saline?   The Impact of Needleless Connector Device Design on Central Venous Catheter Occlusion in Children: A Prospective, Controlled Trial  Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 2, 2006 85-90   © 2006 American Society for Parenteral and Enteral Nutrition Susan Schilling, RN*, Darcy Doellman, RN, BSN*, Nancy Hutchinson, RN and Brian R. Jacobs, MD From the * Division of Home Health Care, Infectious Diseases, and Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio Background: Intraluminal occlusion is common in children with central venous catheters (CVCs). Although multiple factors predispose CVCs to occlusion, reflux of blood is frequently implicated. We hypothesized that use of either a single-valve or positive-pressure-valve needleless connector device would reduce CVC occlusion rates in comparison to a standard device. We further hypothesized that saline would be as effective as heparinized saline flush in preventing occlusion and infection. Methods: CVC lumens were prospectively capped with 1 of 3 needleless connector devices in a 4-group design. Group 1 lumens were capped with a standard device, group 2 with a single-valve device, group 3 with a positive-pressure-valve device flushed with heparinized saline, and group 4 with a positive-pressure-valve device flushed with saline. Data were obtained regarding occlusion and infection rates and user satisfaction. Results: Three hundred sixty children with 599 CVC lumens completed the study. Complete occlusion occurred in 19/150 (12.7%) lumens in group 1 in comparison to 2/150 (1.3%) in group 2, 5/149 (3.4%) in group 3, and 6/150 (4%) in group 4 (p < .05). There was a trend toward a 2-fold greater infection rate in group 4. User satisfaction was higher in groups 2, 3, and 4 than group 1 (p < .05). Conclusions: CVCs capped with a single-valve or positive-pressure-valve needleless connector device have lower complete catheter occlusion rates than those capped with a standard device. Heparinized saline flush affords no advantages over saline in reducing occlusion rate; however, there was a trend toward lower infection rate with the use of heparinized saline. Nancy Moureau, BSN, CRNI PICC Excellence, Inc. 888-714-1951 www.piccexcellence.com [EMAIL PROTECTED]     -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Kokotis, Kathy Sent: Tuesday, September 26, 2006 5:22 PM To: Chris Cavanaugh; Denise Macklin; venous Subject: RE: Radiology Power ports are already being used for CT and MRI   By the year 2010 all Vascular access devices will be power injectable.  It will be a standard in the industry   By the year 2010 heparin for central lines will no longer be used.  Facilities will be heparin free   But than I believe techs will be cross trained to do vascular access procedures as there will be no new nurses to end the shortage   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] [mailto:[EMAIL PROTECTED] On Behalf Of Chris Cavanaugh Sent: Tuesday, September 26, 2006 7:28 AM To: 'Denise Macklin'; 'venous' Subject: RE: Radiology Denise, you are absolutely correct.  My focus has been MRI, not CT, however, I would not be surprised that what I have found in MRI departments mirrors what you have seen.  There are many MRI techs who have no idea what a “power PICC” is.  There are departments who have no nursing backup, techs only and they have rules not to touch a central line.  These patients will always get a PIV, or a butterfly just for the contrast, then it is removed.  Some departments have radiology nurses who come into MRI when needed.  Rarely is there an MRI with a dedicated nurse.   When there is a nurse, the contrast injections, either by hand or power injectors can be done through the central line.  The nurses do seem more knowledgeable regarding Power PICCs, in general, though some have never seen one.  I am sure the Power Ports will never be used—too confusing for staff that do not access ports now.  Ports are NEVER used for hand or power injection in the MRI area.  As far as accessing the Power PICC, mostly I have seen the connection through whatever end cap is on the Power PICC.  Rarely have I seen it removed.  I have never seen them replaced.  It is also very rare that the saline flush of the power injector is followed by a heparin flush, I have only been in one MRI department that had heparin flushes available.  I addressed these and some other safety issues in my talk at AVA. Chris Cavanaugh, CRNI From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Denise Macklin Sent: Monday, September 25, 2006 11:39 PM To: venous Subject: Radiology You may respond to me privately, but I bet many on the list would be interested.  I have found in my travels that radiology departments are doing many different things when it comes to infusing contrast into power piccs for CT scans etc.  Some infuse through the connector, some take it off and mainline, some change the connectors others do not.  If you would like to share what procedure your radiology department is currently using, I am putting together some data on this topic.  Let me thank you for all your input in advance.  This is really an interesting question Denise Macklin