Our PICU is reevalating the use of TPA due to increase occurence of CLABSI. They are going off of the below article.
The adjusted odds of developing a CLABSI was 3.59 times greater in those patients who received TPA compared with those who did not (95% confidence interval [CI]: 1.86-6.94)
https://www.ncbi.nlm.nih.gov/pubmed/24559598
My worry is though that they will or are just taking out the PICC line or other type of CVC and then putting in a new line and the same thing will just happen again!
Thoughts??
Mary Lynn Rae, RN, MSN, CPHON
Lurie Children's Chicago
Yes, you are probably right. Rather than this knee jerk reaction, what about getting to the bottom of why you needed so much tPA? My guess would be incorrect flush-clamp-disconnect sequence for the type of needleless connector being used, incorrect CVAD tip location, or occlusion could be drug precipitate and not thrombotic at all. 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 think the title of the journal article, THE ROLE OF TPA USE AND SYSTEMIC HYPERCOAGULABILIITY IN CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS is misleading. From the title, my knee-jerk reaction was that the authors were suggesting that tpa use increased the risk of infection. After reading the study, I understand that the authors used tpa as a surrogate for thrombosis and are postulating a causative relationship between thrombosis and infection. As Lynn pointed out, preventing thrombosis/occlusions is the best defense and unless the cause is identified, as Mary suggested, removing and replacing may produce the same result.....another thrombosis/occlusion.
Nancy Rose