I was wondering...which of you out there allow IV RNs only to instill Cathflo or have P & Ps allowing any staff (with competency) to Cathflo a line? I'm tring to get a rather large poll, so the more of you that reply, the better...thanks.
I was wondering...which of you out there allow IV RNs only to instill Cathflo or have P & Ps allowing any staff (with competency) to Cathflo a line? I'm tring to get a rather large poll, so the more of you that reply, the better...thanks.
Related to PICCs: charge nurses (RN) in our facility with competency verification. Still working on getting those trained.
We have a patient with a portacath which we can't aspirate blood thru. We reaccessed x 2 without success, and have done a dye study which showed a fibrin sheath. Cathflo was used without success. Am wondering if anyone has a order set or protocol for a cathflo infusion to get rid of the sheath. I know I have seen it discussed on this listserve before, but we have never done any here, and was looking for information of doseage and potential complications, what monitoring needs to be done and for how long..........etc. I appreciate any help. Thank you.
I wrote the protocol for the Infusion at our hospital and have published a booklet as well. I would be glad to share it with you. Email me at [email protected]
Thanks
Patty
Any staff nurse with the competency.
We have a competency/learning module RNs must complete/be certified prior to using Cathflo. All certified PICC RNs in our facility act as resources when no other certified RN is available. This is applicable to our Critical Care Units, and the floors.
Frank Gran RNIII, Kaiser Medical Center, San Rafael CA
Frank Gran RNIII, Kaiser Medical Center, San Rafael CA
We allow RN's with competency to admininster Cathflo.
Chris Naylor RN, CRNI, Santa Rosa Memorial Hospital, Santa Rosa CA
We allow RN's with competency to admininster Cathflo.
Chris Naylor RN, CRNI, Santa Rosa Memorial Hospital, Santa Rosa CA
We allow any staff nurse as well as our home health RNs to use CathFlo after taking the inservice and passing the competency validation. We have an experienced RN observe/proctor the first administration by a newly qualified nurse.
Jennifer Rabalais, CRNI, CIC
We allow any RN to use Cathflo. But there is a down side. It may be getting used too much as any RN is not good at eliminating other causes for occlusion, such as pinch-off
Jennifer MCCord, MSN, RN, CCNS
Bethesda North Hospital
Cincinnati, OH
At our Health System the IV team administers Cathflo for all inpatients and most outpatients- they are informed of the problem, assess the line and administer the Cathflo. We do have an occassional patient that gets Cathflo in our AIC
Ann Marie
Ann Marie Parry, RN, CRNI, VA-BC
[email protected]
Artie Hansford, BSN, CRNI
Rivka, do you use heparin flush for your power piccs or saline only and how often and what concentration and amont if heparin is used? What type of injection cap are you using? Thank you!!!!
Artie Hansford, BSN, CRNI, VA-BC
I am not sure what our hospital does. I am in the outpatient infusion center and have we have our own policies. Cathoflo in my opinion should be limited to those properly trained and this includes the administration with supervision x 3. I feel that Cathflo could be over utilized if all nurses can use.
Being a CRNI, I think it woul be best to teach the nurses how to prevent occulsion, "pinch off syndrome" signs, etc.
My questions to those of you using cathflo -
how often is it being used?
and what is the percentage of in house PICCs that require declotting during their stay?
Thanks!
Bud Lavin, RN, CEN
Manager - PICC Team
St. Mary's Hospital
Passaic NJ
lavinb(at)smh-passaic.org
Bud Lavin, RN, CEN
Manager - PICC Team
St. Mary's Hospital
Passaic NJ
lavinb(at)smh-passaic.org
Lisa Y., Team Leader IV Team UPMC St. Margaret Pittsburgh
IV nurses and chemo nurses who have been signed off by us.
Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy
Any nurse that has been education during orientation and annually can administer Cathflo. Our P&P states to assess the line, if no bld return or occluded then the patient is to reposition, try go hub to hub and if still not bld return or change in patency then this line is indicated for thrombolytic therapy. We are in the Home Care setting.
Kathy Kokotis
Bard Access Systems
I think the staff RN's should be part of the process whether it be educational or doing the procedure.
The key is the definiton of what an occluded catheter varies from RN to RN. An occluded catheter is one that does not give you 3cc of free flowing blood return and /or has sluggish infusion. Most RN's do not even check blood return and infuse if they have no blood return. But that is the definition of an occlusion. It is not complete blockage as the definition. I think we undertreat catheters just like we miss patients who were PICC candidates. It goes back to understanding the process
kathy
Kathy Kokotis
Bard Access Systems
Kathy, where is this idea of obtaining 3 mL of blood coming from. To my knowledge there has been no research or any evidence to identify this specific quantity to establish the fact that a catheter will provide a blood return. I have heard this in one other place but seriously question this idea.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
We would not instill Cathflo into a line that was giving a adequate blood return such as this.In our facility-on the MDs or IV nurses are allowed to instill the Cathflo..
http://www.gene.com/gene/products/information/cardiovascular/cathflo-activase/insert.jsp#indications
CLINICAL STUDIES Three clinical studies were performed in patients with improperly functioning central venous access devices (CVADs).
Restoration of function was assessed by successful withdrawal of 3 mL of blood and infusion of 5 mL of saline through the catheter.
I have seen this somewhere else also. When I remember I'll post it.
[quote=lynncrni]
Kathy, where is this idea of obtaining 3 mL of blood coming from. To my knowledge there has been no research or any evidence to identify this specific quantity to establish the fact that a catheter will provide a blood return. I have heard this in one other place but seriously question this idea.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
[/quote] Staff R.N. with no affiliation to any product or health care company(your basic front line grunt/wage slave)Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
we are working on this in our hospital. Does anyone have a nursing competency/sign-off they'd be willing to share? Please e-mail me- Thanks
[email protected]
Thats a strange criteria...
Nancy Rose RN IV Team VA Medical Center Wilmington, DE (800) 461-8262 ext 4830
At our 60 bed hospital, IV Team (2), Oncology (2) and Hemodialysis nurses, all RNs, are the only ones de-clotting lines.
Nancy Rose
We allow any staff nurse to declot: they just need to follow the P&P. If they fail after 2 doses, then the Vascular Access Service Team should be contacted by an "PICC Eval" order, and a brief description under comments as to the problem. eg., "Unable to declot after 2 doses. Please evaluate." We then order a CXR. The vast majority of the time it's a dislodged PICC tip causing the catheter dysfunction. We consider declotting to be a staff nurse responsibility. More in depth evaluation is up to the VAST.
Nadine Nakazawa, RN, BS, VA-BC
Indications of a catheter blockage
*Sluggish flow is defined as lack of brisk, free-flowing blood return (<3 mL in 3 seconds).8
as per the recommendations for the use of cath flo on their website cathflo.com. I think this is where the idea of 3ml of brisk blood return came from. They used the following as a reference for this guideline:
Cummings-Winfield C, Mushani-Kanji T. Restoring patency to central venous access devices. Clin J Oncol Nurs. 2008;12(6):925-934.