We have a patient on Milirone at home on a CADD continuous pump via a dual lumen PICC. The dose is 7.5ml/hr and the bag change is every other day. I have a pharmacist not wanting to send saline for line flushes due to the possiblity of bolusing the patient and then the patient being without the drug for the amount of time the milrinone goes through the catheter. I would like to know what others are doing and what is recommended for patients that have the continuous infusions. Our protocol states to assess line patency and flush with saline before and after the medications.Â
Also would you recommend switching lumens each bag change.
There is no evidence to support the practice of a routine flush on a continuous infusion to maintain patency of the lumen. The pump exerts enough positive pressure to keep the lumen patent. There could be fibrin/thrombus outside the lumen and inside the vein that creates an obstruction though. The priming volume for each lumen is probably less than 0.5 mL. This rate will give you 0.125 mL per minute. So it will take 4 minutes for the lumen to displace the saline with drug again. There could be an issue with the drug bolus from the flush - you did not provide the drug concentration. I would only flush the catheter when there is some indication that there is a problem - e.g.occlusion alarms on the pump. This is not a vesicant med, so you have to weigh all the risks of what you are doing.
Why did this patient end up with a dual lumen? I also would not worry about rotating lumens for this drug. Curious to know what others are doing and why. 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
Thank you for your response. We don't necessary flush to maintain patency between bag changes but check a blood return to assess the line patency. If I understand you correctly, you do not feel this is necessary if there is no alarms and the medication is infusing without complications. Is this correct? Would you also recommend this with any continuous infusion?
I do not know why they put in a double lumen, For the most part our patients get a single lumen but there is another group that is inserting these line for a specific physician that often uses the dual lumen. I have attempted to get the rational without success.
When a patient is receiving a continuous infusion, I have never flushed on a routine or regular basis. The only time flushing is necessary would be if there was some indication of a problem such as pump alarms or site complications.
There is evidence that multiple lumens increases the risk of CRBSI simply because there is additional portals of organisms. The need for multiple lumens must be balanced against the risk of multiple insertion sites. In other words, 2 insertion of a single lumen catheter would pose the same risk of hubs and double the risk for insertion sites, so a dual lumen catheter is preferred. On the other hand, when therapy does not indicate the need for multiple lumens they should never be chosen because of the need to maintain both lumens and thus increase the risk of CRBSI. 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