I'm there with you Nadine! We had a clotting issue and changed to the BSCI PASV Vaxcel PICC which helped tremendously, but still had more than I liked. The next move was to the MaxPlus. You are right, in the home, the nurses are "majorly" frustrated by this. I was at my wits end, sent a message to this list and got Lynn's excellent explanation. We switched to the prefilled syringes and have seen a decrease in our occlusions as a result!! The nurses had been ready to hang me if I didn't give them Heparin back. They didn't understand that it wasn't the heparin!!
Not that life here is paradise, but I haven't seen the noose hanging outside my office door for a while!! <g> Good Luck!! Best, ann Ann Williams RN CRNI Infusion Specialist Deaconess Home Services 600 Mary St. Evansville, IN 47747 812-450-3828 812-450-4665 FAX -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Nadine Nakazawa Sent: Thursday, October 19, 2006 10:31 AM To: [EMAIL PROTECTED] Subject: Re: Prefill syringes & backflow Thanks, Halle for pointing out this problem. As I normally hold the plunger as I disconnect the flush syringe, I hadn't realized this was such a widespread problem. Thanks to all the others on this listserv who pointed out the differences in the various types of prefilled syringes out there. We've been struggling for the past 6 months trying to implement MaxPlus with NS flush/lock only with a transition from Groshong PICCs to 60% PowerPICCs with mixed results. I keep hearing about clotting problems, some areas are worse than others, and home care is very frustrated. Things are definitely better housewide compared with early summer, but we still have room for improvement. I love technology that addresses these very small details that are nearly impossible to teach every clinician out there who uses catheters, but make it nearly foolproof to prevent problems. This syringe discussion got me moving yesterday and I've switched my whole agenda for my VAD Committee meeting next Thursday. We're moving this topic up to the TOP of the agenda. I'm getting excited that this other piece of the puzzle (too many clotted lines) may be solved with a change in product! Of course, there are many causes and technologies around this topic, but this is an important one. I always learn something new on this listserv! Nadine Nakazawa >From: "Lynn Hadaway" <[EMAIL PROTECTED]> >To: "Hallene E Utter" <[EMAIL PROTECTED]>, [EMAIL PROTECTED] >Subject: Re: Prefill syringes & backflow >Date: Wed, 18 Oct 2006 15:53:07 -0400 > >You are talking about the syringe rebound problem that occurs with >traditionally designed syringes. When you flush all the fluid into the >catheter, the gasket at the end of the plunger is compressed. Then you >release the pressure on the syringe plunger,causing the gasket to >expand and pull fluid back into the syringe barrel. Blood is also >moving back into the catheter lumen at the same time. Traditional >syringes were not designed with the physics of flushing catheters in >mind. You are correct - we do not know if a positive displacement >connector will have enough fluid displacement to overcome syringe >induced reflux as well as the disconnection reflux. > >There are 2 ways to handle this issue. >1. use a syringe designed to prevent this problem. There are 2 on the >market, one by BD and one by Tyco Kendall 2. do not completely flush >all the fluid from the syringe to avoid compressing the gasket on a >traditional syringe., > >Lynn > >At 8:13 AM -0600 10/11/06, Hallene E Utter wrote: >>Has anyone else had problems with the prefills "backing up"? What I >>mean is after you remove the cap and push the fluid up to the tip, if >>you take your thumb off the plunger for an instant, the plunger and >>fluid slip back a bit. This is not so significant before you flush in >>terms of a significant amount of air,esp in adults, but if you are >>using a neutral displacement valve cap and you release your thumb from >>the plunger before you unscrew the last syringe (which would be normal >>in my opinion), it allows for blood to back up in the tip of the line. >>Even with a positive displacement cap, I am not sure the over flow >>with unscrewing is adequate to flush this backflow back out of the tip >>thoroughly. Particularly important if only using saline flushes. Anyone else seen this phenomena? >>Even clamping before you unscrew, unless you keep your thumb and >>hencefore pressure on the plunger, would not prevent this "plunger >>slippage". Any comments? I had the ICU nurses point this out to me >>and they were sure right. The fluid slips right back into the syringe >>after you push it up to get ready. >> > > >-- >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 -------------------------------------------------------------------------------------------------------------------- This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please notify the originator of the message. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of Deaconess Health System.
