Is there any difference in efficacy when giving an antithrombotic infusion for fibrin sheath on a port line, by giving it either PIV or other means.
The port site has a rash from the occlusive dressing and the urokinase is due, and it would be nice to give that area a decent rest, or does the local effect of the infusion have that added action as opposed to just circulating med level. I can find no mention regarding this
thankyou
The indications for urokinase administration for a venous catheter occlusion is to administer 5,000 IU "in the occluded line". Administration for thrombi lysis can be givin IV. I would do port site care and cover with a steile gauze for 48 hours to give the rash a rest. Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
Urokinase does not have a labeled indication for catheter clearance any longer. After it was pulled from the market in 1999, it returned but without this indication. So read the package insert very closely. Are you certain that urokinase was ordered?
Anyway, the original question was about the site for injection. If there is a skin issue at the site of the implanted port, this can be infused through another site. The fibrin sheath is around the extraluminal catheter surface so the circulating blood with the infused drug is what will reach the site of the fibrin. 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
This is for infusion not catheter line lock, for the extrinsic fibrin sheath. A sterile gauze covered with tegaderm has been the method of dressing for the past 3mths so that only an outline is in contact...
We do not have cathflo in this country, only the tPA for cardiac clearance size doseage, so UK is the only med available.. and yes being used outside its recommended label [S29] prescription, but is working.
thank you for your input
OH, the UK. Very different. All drug and device discussions are dependent upon the country one is in as there are quite different indications, uses, etc. In the US, it would not matter whether we were using a low dose infusion or instillation - it would be off-label use. 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
Sorry for using initials.. UK was short for urokinase, I hadnt realised I had done it..
funny how humans really are the same [we are aint we??] but each country has different rules and often side effects!.. but yes very off label use but as long as it works,is the main thing
thanks again
just a whole new thought on the cause of the rash from your occlussive dressing. do you use a skin prep after cleansing your site and prior to application of your tegaderm? I have often found that when a skin prep is used, if the clinician does not give the prep adequate time to dry (the gloss should be completely gone and when you touch the skin, your gloves do not "stick") prior to placing the tegaderm, the patient will often have a nice little rash that is located under the tegaderm and is exactly the same size as the dressing. Many, many times staff tends to jump to the conclusion that the patient is "allergic" to the dressing, when often what I just mentioned is the true case. I was told by my wound care nurse that not allowing the skin prep to dry COMPLETELY before applying the tegaderm "traps" any chemicals between the skin and the dressing and therefore causing the irritation, rash and even blisters that you will see occur. Just a thought and hope it may help.
A reason to educate staff about the need to allow thorough drying, but not a valid reason to stop using these skin protectant products. I would not apply a securement device or dressing without this solution! 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
Have tried everything. now sensitive to cavilon.. even when applying say 4hrs before accessing port, and 12 hrs from last dressing. Dressings are on for the 10hr of infusing 5x perweek.
skin care at present is wash EMLA cream off with water, over the port bump, 3x alcohol swabs used two starting over the bump and circling to the outer edges of dressing radius, and last swab over port. allowed to dry for about 3mins and then betadine applied only on port bump and allowed to dry about 2-3mins. Huber needle inserted and a tegaderm with a gauze swab affixed to it so that only adherence is the ring around of about 1/2".
this country has had a warm summer, so sweating has been a problem. IV3000 lasts about 2hrs, micropore tape across just took the skin off with it
Skin goes from mild redness that would be ignored by most nurses to blister and loss of skin as dressing then seem to adhere to superglue status, in one session. Yes know how to remove tegaderm in the removing chewing gum way.. So then go to soap and water for the surround and only alcohol and betadine on the bump. Port has been in use for nearly 2 yrs, no infections at this stage.
I can only work on the standard that good skin integrity is the best barrier.
You are correct -skin integrity is critical. At this point I would think that the patient is having a contact dermatitis from something that is being used. I would stop everything. Do you have access to a wound care nurse specialist? They are experts at managing skin issues. We are waiting for the CDC to release their new guidelines but prilimary informtion says they are going to state that povidone iodine should only be used when there is a contraindication for chlorhexidine gluconate. I would surely get rid of the betadine, maybe wash with soap and water, remove with sterile water or saline, and the least amount of dressing and stabilization during infusions only, then remove needle so that nothing is on the skin. There may need to be some type of cream applied to decrease the inflammation, maybe steroid cream or even something like A&D ointment, something to heal this skin area, that may require physician order or a protocol from the wound care nurse. 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
I agree Lynn, I certainly did not mean not to use the skin prep - just proper education.