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georgia kim
port-a-cath accessing and using

I have a question regarding port-a-cath.  If port is be able to flush, but not blood return.   What is first thing to do?  Declot using tpa or flow study first then use tpa.  There is two different approach in department. What is reasonable way and evidence practice way to approach with port-a-cath.

lynncrni
First you must do a thorough

First you must do a thorough assessment to determine if the reason for the occlusion is thormbotic in nature. Then if you think it is, and there are no other issues with the implanted port, you can do either tPA first or a dye study. I am not aware of any studies that have shown one to be superior to the other, although I have not looked at this in a while. If you choose the tPA and produce a blood return and use the catheter, you may expect to have the same thing occur when the patient returns for the next treatment. You are probably reaching the fibrin/thrombus at the catheter tip which is breaking down with the tPA. Then over the next weeks it regrows to produce the same problem with the next visit. The only way to reach the fibrin on the outside of the catheter is a low dose tPA infusion. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

georgia kim
How low dose of tpa infusion

How low dose of tpa infusion or can i get some information regarding dosage.

my next question is if port used infusion medication. Deaccess and reaccess then can I use for TPN.  We all know that PICC needed new line for tpn.   There are some debating regarding this matter. what is you thought?

Thanks

lynncrni
There is no evidence

There is no evidence anywhere that I know about supporting the concept of only infusing parenteral nutrition through a so-called "virgin" line or a catheter that has not been used for any other infusion. So a PICC or port or any CVC that has been used for other infusions can be dedicated to parenteral nutrition. 

I am sorry but I don't understand your tPA question. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

thomas tucker
then what?

OKay- here's my question.  If you have had troublewith blood return on numerous occasions, but no porblem with infusions,  and had two dye stuides showing no problem, is it safe to still use it for infusion?  Sometimes it draws, and sometimes it doesn't, sometimes after TPA, and sometimes not.  But two dye studies have shown no problem.  The question is- do we still need to get a dye study every single time we use it for weekly chemo?

lynncrni
I would say yes or use some

I would say yes or use some method to remove the fibrin sheath. What are those dye studies showing? The intermittent nature of the blood return could be related to the fibrin tail or flap or to a suboptimal catheter tip location. Use of tPA instilled into the catheter is only reaching the fibrin inside the lumen or directly at the catheter tip. There is still fibrin left along the catheter walls and it is repropagating to cover the tip between uses. You will need a tPA infusion to remove the problem for a longer period but the fibrin can still grow back again. The risk with a fibrin sheath is retrograde infusion backtracking between the catheter and sheath producing a nasty extravasation injury at the insertion site. You have to work hard to eliminate this risk for your patient. A positive blood return is the first thing I look for when reviewing medical records in such legal cases. Lynn

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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