Note: forwarded message attached.
--- Begin Message ---Gina,You are doing this correctly. Let the dose dwell for 30". Most places will repeat x1 if still unable to aspirate blood. No positive pressure against an occluded catheter-- your stopcock method is perfect!Betsy
Ward Gina <[EMAIL PROTECTED]> wrote:So tell me what dose you give?When it is a partial occlusion we instill the full 2mg as directed.When it is a full occlusion we use the stopcock method to get whatever will be pulled back in the catheter, and recheck and eventually get the whole thing in their as it dissolves.Thanks for your time,Gina
From: Betsy King [mailto:[EMAIL PROTECTED]
Sent: Fri 10/20/2006 11:06 AM
To: Ward Gina
Subject: RE: DVT with picc lineNo, just the 2 mg dose...
Ward Gina <[EMAIL PROTECTED]> wrote:Thanks so much !You made mention of the whole dose. Are you referring to the 2mg, or the whole dose of the recommended for AMI?thanks, Gina
From: Betsy King [mailto:[EMAIL PROTECTED]
Sent: Thu 10/19/2006 11:08 PM
To: Ward Gina
Subject: RE: DVT with picc lineGina,The PI states the only contraindication is hypersensitivity to the drug. There are other precautions, however--as you have noted.Also note that the blood levels of TPA return to endogenous levels after 30 minutes--and this is if you inject the whole dose into the circulating bloodstream (which we don't).The added fun is: It works 9 out of 10 times!Betsy
Ward Gina <[EMAIL PROTECTED]> wrote:Thank you very much.Good info on activase. We are relativley new with the picc lines. So we read alot and react to everything. The activase handout states several contraindications.Thanks, Gina
From: Betsy King [mailto:[EMAIL PROTECTED]
Sent: Thu 10/19/2006 12:59 PM
To: Ward Gina; IV listserve
Subject: RE: DVT with picc lineIt is impossible to tell whether the PICC "caused" the DVT, but index of suspicion is high with any patient who has an indwelling line. Yes, patients with PICC lines have an increased incidence of both infection and clots, these are the most common risks of the procedure. For this reason it is always prudent to weigh risk vs benefit before placing any line and make certain the line is appropriate for the clinical situation.Sounds like it was the right line for this patient...It is possible that with a bed bound pt with arms elevated might not develop sx of DVT until returning home and getting up and about, and also that the clot continued to accumulate and get bigger after d/c, thereby causing sx post d/c sx that were not there prior to d/c.I would like to respond to your query as to whether or not the cath flo was involved in the bruising.Cath flo is used for declotting lines. It is given in doses that are approximately 1/50th of the therapeutic dose for thrombolysis in the setting of AMI. There simply is not enough drug to affect clotting or bleeding times and it has been demonstrated to be safe to give to all populations--including infants. There are NO contraindications for it's use, except for hypersensitivity. There seems to be a lot of misinformation out there about this. Hope this clears some of that up.Hello all,sorry to attach to a prior email but I seem to be "not allowed " to send a mail to the group.Pt scenario I need some guidance with;Pt in hospital needing TPN after surgical complications (carotid endarterectomy then suffered vocal cord paralysis as well as dysphagia requires g tube etc. ) ; I insert a picc line right basilic vein ( 2 attempts) on 9/28 , on the next day he has a partial occlusion in one of the lumens. I use cath flo activase successfully ( his surgery had been 2 weeks prior). Patient ready for discharge and I come to remove the PICC line on 10/4 , line removed intact insertion site good and no redness, edema, etc...but I did notice a significant amount of bruising on that arm below the picc insertion site ( he did have scattered bruises elsewhere alread , and said that had been there for a couple days) ???? cath flo source??The big thing is; he returns to the hospital on 10/13 with diagnosis of chest pain, ventricular arrythmias has peripheral i.v.'s for the stay. They call me to come start a peripheral line because they cant get one. His current I.V. just above antecubital in the right side appears to be infiltrated with significant edema in arm. He was discharged yesterday and today I hear from one of the OR/Home health nurse that he had a DVT in the right arm.I pull up the ultrasound report done on 10/16 and the impression is "thrombus within the right basilic and cephalic veins".So.......do you think this is picc related? I am wondering why 10-11 days after picc line removed he develops the edema?, no signs of circulatory changes while picc line in. Did it take a while for the thrombus to get large enough to cause the circulatory impairment???could you please share with me any input??? Thanks, Gina Ward R.N., C.P..A.N.
From: [EMAIL PROTECTED] on behalf of Michelle Hansen
Sent: Thu 10/19/2006 8:41 AM
To: Laura Cook RN; Lynn Hadaway; [EMAIL PROTECTED]
Subject: Re: reverse taperingI love the reversed tapered catheters! In my opinion it does prevent a
whole lot of bleeding at the insertion site and allows us to place a
bio-patch on at the time of insertion. If the patient has a lot of
bleeding at the time of insertion, then we gauze. We have not had an
increase in phlebitis or DVT's.
Michelle Hansen, RN
Northeast Baptist PICC Nurse
office 297-2422
pager 235-9779
>>> "Lynn Hadaway" <[EMAIL PROTECTED]> 10/18/2006 2:52 PM >>>
I am not aware of any studies on this design feature. This feature
was added a few years ago by many manufacturers based on the fact
that there may be some bleeding immediately after insertion. As far
as I have seen, this is a design feature that is also a marketing and
sales tactic but there is no clinical evidence to support pro or con.
If someone knows of something that I don't, please share it with us.
Lynn
At 3:58 PM -0400 10/11/06, Laura Cook RN wrote:
>Does anyone know if there are any studies out here on reverse
>tapering of PICC lines and an increase incidence of DVT's? If a 5
>french PICC tappers to 7 french at the hub.....wouldn't the patient
>be more likely to develop phlebitis?
>
>Any thoughts on this?
>
>
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Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
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This email and any files transmitted with it may contain information that is PRIVILEGED AND CONFIDENTIAL. It is the property of the Baptist Health System and is intended only for the use of the intended recipient. If you have received this email in error, do not disseminate, distribute, forward, print or copy this email or any of its' attachments. Immediately destroy/purge the email and all attachments and notify the sender by reply of email. Any misuse/abuse may result in disciplinary action and/or legal liability. Unauthorized interception of this email is a violation of federal law.
Betsy King R.N. CRNIIV Support ServicesP.O.Box 3905Truckee, California 96160-3905530-587-7770
Betsy King R.N. CRNIIV Support ServicesP.O.Box 3905Truckee, California 96160-3905530-587-7770Betsy King R.N. CRNIIV Support ServicesP.O.Box 3905Truckee, California 96160-3905530-587-7770
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