We use a CADD pump to administer Cloxacillin IV for 4-6 weeks (q 6 hours) and we are noticing a lot of occlusions with this even if we flush the line with 30 cc of NS once a day with the change of bag. The pump is set to administer 1cc/hour to keep vein open instead of the usual 0.4cc.
Do you have issues with occlusion and cloxacillin administration, if not, how do you administer it?
Thanks a lot,
France Paquet,
clinical practice consultant
McGill University Health Center
You did not state what type of catheter and if some type of CVAD, where is the tip located. Occlusions are caused by numerous factors and tip location is one of the most common. If using PICCs that are suboptimally placed in the mid or high SVC, this is probably the cause. Also, are you giving any other medications through this catheter that could produce a drug precipitate causing lumen occlusion. If using a peripheral or midline catheter, what is the pH and osmolarity of the final solution? These factors also add to the risk of vein irritation and thrombosis at the catheter tip causing obstruction. Thinking of any rate as one that will keep a vein open is misleading because there are so many other factors involved. 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
Hi Lynn,
Thanks for your reply. We are talking about pts with PICC, optimally positionned, at the SVC/RA junction, installed under fluoroscopy. The liaison nurse tells me that it only occurs when they use cloxacillin.
These patients are on cloxacillin IV only.
I posted on this topic because I cannot find the reason why it occludes beside the solution itself. I was wondering if it only happens to us? If so, I was wondering how others were administering cloxa IV. Intermate VS Cadd pump, diluted in how much, what final concentration...
France
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
Cloxacillin is not listed in the 2010 edition of Intravenous Medications, so I cannot quickly locate any compatibility information. I would check with the pharmacy for all info about this drug. Are they flushing the line at any time with heparin? Are they always flushing with saline before and after if using heparin? Have you sure this is a drug precipitate problem and have eliminated the possibility that this is a thrombotic cause? 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
Hi again Lynn,
I am quite sure this is not a thrombotic occlusion but I guess that anything is possible! It is just strange that it occurs only with Cloxacillin...
To answer your question about the heparin, the PICC's are not locked therefore, no heparin is given in the line. We give it using the CADD pump with KVO between doses. The line is flushed with Saline at the time of changing the bag with 20cc of NS.
France
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
The only other thing I can think of would be the preservative in the saline. Are you using a normal saline solution with or without a preservative? One common example is benzyl alcohol found in most multiple dose vials. If you are using a prefilled syringe or a single dose vial, those do not contain any preservative. If it is not thrombotic,then the next option would be drug precipitate. Given the method of infusion, this flush seems to be the only thing left. 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