Our hospital converted to Invision-Plus neutral injection caps a year ago. At that time, we also deleted heparin as a routine flush on all PICCs and central lines other than ports and HD caths. Since then, our catheter occlusion rate, withdrawal and 2way, have skyrocketed in spite of repeated and reinforced inservicing. We started placing mostly Power PICCs at that time also, however the occlusions are occurring on all the saline only CVADs. Several team members and floor nurses have also noted that occlusions may occur within hours of aspirating for blood return followed by proper turbulent flushing, without any intervening entering of the lumen. Many patients are getting repeat occlusions / tpa administration, which is extremely time-consuming and frustrating. Is anyone else seeing this and what are you doing about it?   Thanks, Janet Brown-Wise, RN
Janet,
I don't see less occlusiion rates with In-Vision then I do with Ultra-Sites, Smart Site Plus, or Clear Sites. I work in the LTC sites and I attribute the high occlussion rates due to extended wait times to flush after delivery of the intermittent ABT and poor power flush techniques. I see no evidence that it's better, and if it's needed the most it's the LTC sites due to poor flushing techniques.
Ken Thomas, RN
Institute of Nursing Excellence, Inc.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Robbin George RN VA-BC
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
My name is Lisa I was one of the nurses at AVA that did the study for the poster. Most of the nurses are noticing a occlusion with just a pressure devices alone. When we added the Nexus antireflux device to our cap we reduced our occlusins from 30% to 10 % with Heparin and 12% with saline only. During the month with saline only we also switched our prefilled syringes to 3ml and 10ml and some of our floors were not stocked with the 10ml. Since switching the lines I am callled about usually have the wrong cap in place, multi lumen and have been poorly flushed, or come in from outside the hospital where the antireflux device is not used. I dearly love the antireflux the device. It works great. I know people are trying to get us to switch to the max plus and I am praying this does not work I think it will only ask for trouble. So my advice is to try this device even if you think it is going to cost a little extra, it really saves in the long run. We also placed on our peripheral lines with great success.
By the way the device we are using has been pressure tested for ct scanners, I do not think the max plus is. What are you institutions doing about the CT's
lisa
Kathy Kokotis
Bard Access Systems
Occlusion increases have so many reasons. Is it the lack of heparin? Is it the new needleless system? Or is it the triad of virchow that causes extraluminal and intraluminal occlusions. You have to separate the factors to identify the cause
Kathy Kokotis
Bard Access Systems
At my hospital, we changed to MaxPlus caps and PowerPICCs at the same time, approx.
1- 1/2 years ago, also deleting heparin flushes on the PICCs and Triple lumen catheters. We also have had problems with increased clotting, so we're looking at what we can do to decrease this trend. We will be changing our (normal saline)flushing to q 8 hours (it was being done once a day, and before & after intermittent meds) and we have been doing reinforcement during competency fairs with all the RN staff. There was a lot of variation in technique that could have accounted for some of the problems. The other change for us is that the staff RN's do the flush now, whereas before we were doing it (if it was a heparin flush)--and we had groshong piccs that didn't require heparin. There were high hopes that a positive displacement cap would get rid of the heparin and save time and money with fewer clotted lines, but we're not seeing it working out that way. I thought that the Invision-plus neutral cap might be an answer, but it doesn't sound like it from the problems you're having.
The importance of technique and following proper clamping protocal is always the challenge when the responsibility of line maintainence shifts. The MaxPlus will effectively prevent occlusions with saline flushes if the nurses flush per protocol and disconnect the syringe PRIOR to clamping.
If the staff continue to follow the old method of clamping before they disconnect, the positive displacement feature is eliminated.
Thank you
Kathy Kokotis
Bard Access Systems
These fancy devices do nothing to the outside sleeve surrounding a catheter. Catheters will clot it is called a fibrin tail, mural thorombosis, and fibrin sleeve. Did you ever have a patient cough and all of a sudden get a miraculous blood return. It is called a fibrin tail. Clotting is a function of the patients risk factors just like thrombosis is. I question those that say it is how the RN's maintain the IV line because that is only part of the story. The inside occlusions.
kathy
Kathy Kokotis
Bard Access Systems
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Occlusion is very complex. One issue that might have been overlooked is the use of low rate primary bags often referred to as flush bags with secondary sets. In between intermittent drugs the low rate (10 mL - 25 mL) is used to clean the IV tubing and catheter. If you do the math 10 mL infused over one hour is not the same as a 10 mL manual flush. In actuality the IV fluid pathway may have not been cleaned sufficiently. In addition the low rate is not sufficient to prevent reflux with suctioning, coughing, etc. (anythin that increases negaive intrathoracic pressure. Lastly, many patients in ICU such as trauma, cancer, etc. already are at high risk for thrombosis. Have you tried flushing manually every shift on lines that are continuously connected to pumps? Also are you closing the clamps on the CVC,x or the extensions. Just a few thoughts. The InVision-Plus Neutral is not the cause of the occlusions. It has zero fluid displacement, has 0.027 priming volume and a straight through fluid pathway. It does not have any reflux at the time of connection or disconnection.
Denise Macklin