What do other home health care services teach? When patients with a central line are admitted to a home health care setting, do the nurses teach the patients to check for a blood return before starting the infusion and after the infusion is complete? We do not teach patient/family to check blood returns. We teach them to flush before and after the infusion and then when the home health nurse makes a weekly visit she is expected to check the function of the central line, including blood return. We have found that the lay person (pt/family) are not comfortable checking for a blood return and then may not flush appropriately after checking a blood reurn despite very specific instructions. Often, when patients/family check blood returns, we have to declot the central line. What do other home health services teach patient/family members -- check blood return or not? Is there a standard of practice or reference available regarding this issue? If so, can you please share the reference/standard? Thank you in advance for any feedback.
I don't work in home care but your process is the one I have heard done by the home care nurses I speak with. The patient should be taught how to flush for resistance before and to clear the lumen before and after. Blood return should be assessed by the nurse on weekly visits. See the INS Standard on Flushing and Locking. This does state that you should assess for VAD functionality before each infusion and gives several points to do this. This does not address home care because there is no published evidence to use for writing such a standard. You would consider your setting in the home and the patient and family knowledge and skill level, along with the outcomes you have experienced. Are the medications infused in the home vesicants or not? Most likely they are not. You would need to teach the patient about signs of catheter malposition like strange chest pains, or any discomfort of any kind, plus difficulty in flushing, along with when to contact the nurse if they have a question. The nurse must assess and document there findings each visit. 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 the Infusion Specialist for home care. We DO NOT teach patients/caregivers to check for blood return. In fact, I encourage the nurses to specifically tell them NOT to, for fear they might see the nurse checking for blood return and think they are supposed to. We do not want patients to check for blood return for the same reasons you stated.......they might not flush appropriately after checking.