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md1
flushing PICCs - turbulent flow etc

Quick question on the push-pause turbulent flow technique of flushing PICC's - I believe there has not been any research base for this technique but it is common practice. In theory it is creates more turbulent flow of saline in the catheter which helps clear the catheter of blood, medication etc.

Recently, the push- pause technique was brought up by a product rep for TPA - who suggested that turbulent flush caused the PICC tip to whip back and forth which helps keep the catheter free of fibrin. Has anyone else heard this explanation? - Catheter tip movement like this could injure the wall of the vein - does anyone know if this is actually occuring with turbulent flushing?

lynncrni
 Such a statement from a

 Such a statement from a sales rep from any company requires that sales rep to produce valid written evidence of that statement. I know there are great reps out there but there are also those that will make self-serving statements to sway your opinion of the products being sold. Anything that comes out of the mouth of a manufacturer's representative, regardless of their job, is considered to be product labeling. This statement has grossly distorted what science is showing. Yes, all CVAD tips can whip around in the SVC. But this will not produce less fibrin. It will produce vessel damage by the catheter tip lacerating the vein wall. I have actually seen a tip cut through the entire wall of the SVC in an animal lab. Infusion-induced catheter movement (IICM) has been studied in animal labs and continues to be studied but it is not a good thing. Rapid, forceful flushing techniques increase the risk of IICM. We are in serious need of more study on all flushing techniques. There is no recognized method to prevent the body's natural defense mechanism from doing their job. Those defense mechanisms would be the serum proteins that attach to the catheter wall as soon as the catheter enters the bloodstream. Within minutes the proteins are joined by WBC and platelets and there can be a fibrin sheath formed on the whole catheter within 24 hours. This is a tough material and will not easily release itself from the catheter. Added to the fibrin will be the increasing growth of biofilm. When this fibrin/biofilm layer breaks off it freely floats into the bloodstream and that is what produces the bloodstream infection. There is no evidence that turbulent technique reduces the amount of fibrin/biofilm that attachs to the catheter wall. The flushing technique may reduce the amount of whole blood that has just been withdrawn into the catheter and therefore reduce the residual blood left to deposit proteins on the internal lumen. Some have raised the concern that techniques encouraging the breakage of the biofilm is not a good thing. We do know that the force of fluid flow produces shear stress. Biofilm growing under high shear stress produces a tougher stronger biofilm, but we really do not know what impact this has in relationship to flushing techniques. Until we do have more evidence, I strongly recommend a slow, gentle steady flushing technique for all CVADs to reduce the IICM and prevent the biofilm from breaking off. I also recommend that everyone expect sales reps to be able to back up what they say in written format. 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

Mary K Fox
Flushing/flow

 

Lynn, Do you have any opinions on running peripherals or CVCs TKO and what those rates would be in the interest of "preserving lines." I am being asked this by a pediatric pallative care team who wants to keep procedures at a minimum.

 

Thanks,

Mary Fox

lynncrni
 There can not be an

 There can not be an evidence-based answer to your question. There has never been any studies that have established a single rate or a range of rates that will be sufficient to maintain the patency on all PIV and CVCs. There is some data for the small ambulatory infusion pumps used most often in home care. The same data does not exists for larger, pole mounted, volumetric pumps used in the hospital. That is why the standards of practice from INS states, "Prior to the inititation of therapy, a Keep Vein Open (KVO) order shall contain a specific infusion rate." There are so many variables including the pump mechanism, the type of needleless connector if used, the patient factors, etc. 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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