I am not an expert in all things IV related so please forgive this probably simple question but need advice. I am to teach a class in the use of cathflo for occlusions. I am comfortable with the PICC lines as have been doing this for some time but have been asked to include ports in the class. This is not something I am comfortable with and have been disappointed that I cannot find much information nor have I been able to get a call back from our rep. If anyone has a step by step poilicy/procedure they would share I would be very grateful- or if you could share any tips I also would appreciate. With PICCS we use negative pressure for most of them but I am very unclear if this is something you can do with a port. Thanks in advance for any assistance.
Yes, the catheter clearance procedure using tPA can be done on an implanted port. Infusing Nursing SOP #56 uses "CVAD" and implanted port is a CVAD. Just make sure you are teaching the current SOP and you will be fine. An implanted port might be more time consuming to clear. The negative pressure would reach the port needle extension set and maybe pull some fluid out of the reservoir, but it may not pull all fluid out of the catheter. So it might take more effort to have the tPA reach the intraluminal thrombus. If the problem is inside the vein at the catheter tip, regular slow instillation should reach that location. Look at the internal volume of the entire system - catheter + port reservoir + port needle and extension set. Depending upon the size of all of theses, the internal volume could be more than 2 mLs but this would be the exception to the general rule. As with all occlusions, a thorough assessment of events producing the occluison will provide lots of information about whether you are dealing with a thrombotic occlusion, a mechanical occlusion, or a drug precipitate. 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 am a Clinical Nurse Trainer for Genentech, and want to suggest that you may want to talk with your rep about having Genentech come in and do the education. They do this free to the hospital and have an excellent program. And have great posters and handouts. And possibly some information that you might not even be aware of. Just something to think about.
Ann Williams RN CRNI
Infusion Specialist
Deaconess Home Services
Evansville, IN
We use the same technique for declotting ports as for declotting PICCs. We have the experience that declotting ports takes less time then declotting PICCs. This is probably due to the fact that for a clot in the port chamber which obstructs the access to the catheter, the trombolytics may have an easy access to the clot once your tPA reaches the port chamber (if you place a new Huber needle which is already filled with your declotting agent). The catheters of thoracic ports are also shorter than the PICC lines.
Thanks so much to eveyone for the comments- very helpfu. Ann- if you could send me the # of a rep that would come to help with this it would be great. I have gotten good handouts from the website but have not been able to get anyone to offer to do training so that would be great- can send to personal Email- [email protected]