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katie CRNI
Declotting hub to hub vs through a new needleless connector

 I am wondering if anyone has evidence that would support the least risky way to declot a complete occlusion on a central line (after they have checked for other causes).  Sometimes it may take a few hourse to instill the entire dose. It is unlikely that a nurse has a few hours to spare to declot. I dont see anything in SOP 56 to give any direction.

What is the recommendation? Do they go hub to hub or through a new needlelss connector?

Do they leave the syringe attached at the bedside and come back repeatedly to cont to try to work the med in or do they have to remove the syringe if they leave?

If they remove the syringe and have not instilled the full dose, what do they do? Is it counted as a dose given? (I would hope they do not try to reconnect the used syringe later but am guessing this happens sometimes.)

If the nurse left the syringe attached and secured to the central line, would that be considered leaving medication at the bedside? 

On a partial occlusion should they go hub to hub or through a NC? I am wondering which technique is least likely to contaminate the line.

thanks in advance for your responses.

Katie 

gmccarter
If I am doing a complete

If I am doing a complete occlusion, I  do the hub to hub. I leave the syringe attached for the full treatment. If you are using cathflo they have nice stickers you can use to label the syringe/tubing with a warning not to use the line. I discuss what is happening with the patient, and have never had a problem. The patient and I discuss the best way to get the syringe out of harms way and often we use paper tape and tape it loosly to the skin or clothes. I usually plan to spend the first 5 - 10 minutes with the patient working a little more solution into the catheter, and return frequently. With a confused patient I usually tape things under clothing and if possible do the treatment when there are other things to keep them busy (family visiting, patient working with activities or therapists or even during a meal).

A partial occlusion I usually do through a new needless connector, remove the syringe, put one of the stickers on it and tape it up in a way to make it inconvient to use.

I don't have the evidence to support my techniques but it seems to work out well.

Hope this helps.

Gail

Gail McCarter, BSN,CRNI

Franklin, NH

lynncrni
 I would always recommend

 I would always recommend removal of the needleless connector and using either the stopcock method or the hub-to-hub method. There will be accumulated blood/thrombus/biofilm inside the NC. We can easily remove these devices and get rid of that problem. I think you must do an assessment of your situation. Are you expecting staff nurses to do this procedure? What types of patients have this problem? What might work in one facility might not be appropriate in another. I am not aware of any studies on these issues, but you should do a literature seaerch so that you are using evidence-based practice. And there is a standard from INS on catheter clearance, so make sure you are in compliance with that document. 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

katie CRNI
 thank you for your

 thank you for your comments.I appreciate the feedback! I read the standards and it gives no direction on going hub to hub or leaving a syringe attached to a patient during a complete occlusion.It talkes about declotting a partial occlusion with a cathflo drip which is an off label use but i have used effectively especially when dealing with a fibtrin tail.  What I am asking specifically is---

#1 if you are declotting a complete occlusion and cannot stay at the bedside, is it safer to declot through a new needleless connector and leave the syringe on (so if it wiggles loose you are not exposing the line) or hub to hub and leave the syringe on.

#2 Is it okay to leave a syringe containing medication attached to a completely occluded central line if the nurse cannot stay at the bedside. I have done a literature search and cannot find any studies that address this directly. 

It sounds as though there may not be studies but I was hoping to find out what others are doing in their practice and their rationale. Thanks again for the feedback!

lynncrni
 You are correct about the

 You are correct about the INS standards not addressing this level of detail. By referring to the standards, I just meant that whatever you decide will need to be in compliance with them such as a written policy and procedure, etc. The standards are not the same as policies and procedures, but are used to guide your development of p&P. As I recommended, I would not use the needleless connector. This would be trying to manage 2 luer locking connections. You can luer lock the syringe to the catheter hub directly and only have 1 luer locking connection. This would be less risk in my opinion, plus you would not have to dissolve and thrombus inside the NC. I don't think there would be any greater risk of the NC luer lock coming apart than the syringe luer lock. The syringe left attached should be labeled with the drug name and concentration and the nurse should be checking back frequently as Gail mentioned. I would not leave this for longer than a few minutes at a time. So a primary care nurse with a full load of other patients and lots of things to do should not be expected to do this procedure. It has always been my opinion that this is a procedure that should be in the hands of infusion/VA specialsts. 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

Random VAT person
   

 

 

Random VAT person
Cathflo rep training

Hi, I have a Cathflo trainer coming to enhance training at our facility.  She told me they mfg recommends direct connection to the hub not the injection cap.   I would contact them for a free inservice.  They have been great so far.  The have many neat free signs including labels to stop someone from injecting into the line while the cathflo is in the lumen.  NICE!!!  and did I say FREE?  :)

 

enjoy,

David

 

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