Hi everyone,
We (small PICC team in local hospital) have recently been told ( by the access team in the large regional tertiary centre) to use the POP technique when dealing with occlusions, prior to instilling cathflo. I have reviewed the posts from 2009, and from general conversations at vascular access events, I know there are different opinions on the matter. I am interested in what the evidence says, and if there is any new evidence. (since the 2009 posts). Apparantly they are going to publish a paper on it, and have come to the conclusion that it is safe and effecient. I have concerns regarding the evidence ,or lack thereof, of proof there is not mobilization of the thrombus into circulation and if there is proof that it does not cause the biofilm to break apart. Thank you in advance!
Kerry McDonald RN
Add catheter damage to this list also. You would need to check with your manufacturer to see what they said about this. Not with the sales rep but with the clinical department! I do not know of any new research and I would need lots of well done research, several studies with very good outcomes to be convinced that the risk is less than the benefits. Sounds like this is being driven by the cost of tPA rather than what is best for the patient. Why not work on prevention instead of trying to prove this highly questional treatment is safe?
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 of the opinion that it is a matter of economics, popping takes less nursing time and no drug expense. They have either already drafted a policy or are in the process of drafting it. My problem is I am just a RN with no advance education, and this is coming from their advance practice nurse. Her opinion carries more weight. The nurse that told us is also the PICC company's clinical nurse specialist. I will pass along your valued opinion on the issue. It wil be interesting to see their study when it is published.
K. McDonald RN, CVAA(c)
Have you seen anything from the PICC manufacturer with information about this technique? Some form of instructions with the company logo? If you are only hearing verbal information from the company nurse, this should raise a huge red flag. Ask, then demand if no response, to see these instructions from the PICC manufacturer. Do not proceed if there is nothing in writing from the company. If nothing, then you can bet your boots that the company is not endorsing this practice and the nurse is acting on her own based on her clinical practice.
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
Totally agree with you Lynn. Prevention is the best method instead of this clinical treatment. No doubt on that, Thanks!
Good health and good sense, two of life's greatest blessings.
Dr. Jarred Mait, MD
429 Lenox Avenue, Miami Beach, FL 33139, USA
Website: IV Division
Wow...Lynn is correct, I wouldn't do anything like that without lots of good evidence. What should happen is they should drill down and find out why the increased use of tPA, if there is one, or at least how much is being used. If it's a significant amount, they need to figure out why. Maybe the nursing staff are not flushing properly. Maybe they aren't addressing pump alarms in a timely manner. What kind of connector are you using? Do you use saline only? The connector is key when using saline only. The only thing that is FDA approved for the treatment of occluded lines is tPA/Cathflo, and there is no evidence that I am aware of, that supports, or not, the POP technique. Disclosure: Cathflo nurse trainer
Sheila Hale, MSN, RN, CRNI, VA-BC, Austin, TX
Totally correct. Figure out the reason for so many occluded lines first. Cathflo is the only type of thrombolytic with an FDA labeled indication for catheter clearance. There is some research on others but those manufacturers have not been to the FDA to change their label.
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
Thank you Lynn for your advice and sharing your expertise.
Kerry McDonald
K. McDonald RN, CVAA(c)
Hi Sheila,
thank you for your feedback
K. McDonald RN, CVAA(c)