Here is our issue. We have a patient with colon cancer being treated with FOLFOX. We had difficulty with her port blood return immediately. For her second treatment we could not get a blood return after 2 doses of cathflo. The patient was with us all day. We got an order for fluoroscopy to check port function. It showed the CVAD in the correct place with ability to flush but with a large thrombus.
The oncologist ok'd for use for chemo. We told him we intended to keep using Cathflo if no blood return in hopes of eating away at that thrombus. we brought the for one day on her off weeks to check for blood return and used Cathflo as necessary to receive blood return. We were always able to get a blood return after one to doses of cath flo. We let each dose dwell for 2 hours.
Patient saw the surgery and apparently expressed frustration with the extra time and visits. She told us he was going to tell us we could do peripheral blood draws and use the Port for Chemo even without blood return. We told the patient that although we know the port is in proper place we were concerned about it eventually becoming totally occluded as well as infection developing in that thrombus.
The surgeon came to speak to us. we told him our concerns and he agreed.
Before patients next visit she was admitted for heparin drip because the thrombus had grown to such an extent that the patients neck and arm were swollen.
The surgeon wanted us to give her chemo as scheduled. we checked with the oncologist and he said to hold dose for one week.
I spoke with the patient while she was an inpatient she has told the surgeon we don't trust him.
Now scheduled for a conference with surgeon. I have no problem with this, but what options do we have.
replacing port and risking the same thing happening"
place a picc
again risking the same thing.
I remember some information about chlorhexidine impregnated PICCs decreasing the risk of thrombus but can't find it.
Has anyone had any experience with this
Forum topic
Wed, 06/17/2015 - 23:46
#1
Carolyn Bonanno
Central Venous Device thrombus
Sorry didn't check it well
We brought the patient in for one day on her off week to check her port function
Catheter associated vein thrombosis with a properly functioning catheter and no signs of infection means the catheter can remain in place and continue to use it. This one is not properly functioning, therefore it should be removed and another CVAD of some type inserted IF the length and type of therapy and partient peripheral vein quality indicates the need for a CVAD. Anticoagulation is also needed if no other contranidcations.
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 don't think it would be safe to do a continuous IV infusion like FOLFOX through a peripheral line, vesicant properties of Oxaliplatin aside. This port must be pulled, but you could reattempt with a PICC on the contralateral side. A single lumen 4F PICC might be small enough to be less irritating to involved vein (a highly anecdotal recommendation). Also I know that people on this list have Cathflo infusion protocols, and this might be helpful in a patient with a known thrombus and a still-functioning line.
Perhaps while the patient is undergoing anticoagulation for the known thrombus, a new line would be less likely to be affected by a new thrombus? I hope this patient's treatment is not being delayed too much, as she is likely adjuvant!! Thrombi are a constant concern in our oncology population. I've never looked into the epidemiology, but I'm sure it's well correlated.
I know that Angiodynamics markets a couple ports with Endexo technology, which is supposed to be resistant to thrombus formation. At least with this product, it is not the chlorhexidine that makes it thrombo-resistant, but the unique polymer blend making up the catheter. There are catheters out there with various antimicrobial properties, but they are not necessarily thrombo-resistant. Anyways, I don't work for Angio, but something like their product might be helpful in patients like this one.
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
Thank you so much for all of your input. I would love to share this with our surgeon although I am not sure he wants to hear from me. I am very afraid he want to use the existing line which has not been pulled yet. The oncologist says she can have her chemo through a viable line. To me this existing line is not viable. I am going to use the Infsuion nursing standards of practice to back me up,