Does anyone have any ideas how to prevent and/or correct fibrin sheaths. We most often put in dual lumens since nurses and patients prefer that extra lumen to do blood draws for labs. Our usual approach is to first use activase. This seldom works, since most of these lines you can still flush, which tells me it is not intraluminal. I do not like to replace these piccs for this reason,  but sometimes we have to. Any suggestions.
Karen RN
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
Hallene E Utter, RN, BSN Intravenous Care, INC
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
Ann Zonderman, BSN, JD, CRNI, LHRM
Methods to eliminate/ remove fibrin sheatlhs seem to vary. I wonder if an aggressive approach to try to force release from the catheter into the blood stream has any repercussions... what is the process/ timing for the biofilm to be degraded/ broken down in the body, will it become a clot hiding somewhere else? Will resident bacteria opportunistacally invade another part of the body? Very thought proviking .... Ann
Ann Zonderman, BSN, JD, CRNI
All our lines are Power PICC so about 50% of the time it is possible to "dislodge" the fibrin sheath by poweful push-withdraw-push-withdraw a few times while the pt moves his arm around and coughs a little. If it fails, then cathflo.
Hallene E Utter, RN, BSN Intravenous Care, INC
What is the dosage and diluent amount for the 2-3 hours infusions of Cahtflo? Is there any data/indications for the usage of cathflo this way?
Thanks
Karen RN
P Luptak (LITE) wrote the quintessential document many years ago regarding the use lytic agents and she does mention the process of "dripping" TPA (2mg diluted in 50 ml isotonic fluid infused via pump at 25ml/hr)--I did confirm this technique at last years AVA conference with the cathflo gurus and have since successfully used the technique
Robbin George RN VA-BC
May I please resurrect an issue.
I have been called to task for recommending a tPa drip (2 mg in 50 ml NS run in over 2 hours) for persistent withdrawl occlusion. We hae successfully reestablished blood return in multiple centra lines (incl PICCs and Ports) by use of this method. We have never seen any complications.
I have now been confronted by an ambitious staff member who suggests that this off-label use of tPa is wrong and I must provide evidence that it is not. We will be meeting with management staff and pharmacy next week.
I did a topic search at this web site and found the attached discourse. I see a reference to P Luptak's document on this issue. I would dearly love to have a copy of what she wrote.
Also could benefit from any other resources.......help.....I'm going into battle!!!
Alma K RN, CRNI
How does the clinician LEGALLY work around an OFF LABEL use?--Does the manufacturer CATHFLO need to research/reevaluate/revise it's data?--The few times I suggested a TPA DRIP for persistant withdrawl occlusion I had the MD (IR or ID) write the order and the Vascular Access Nurse (ME) did the DEED with excellent results-- I believe this subject was once again addressed at Savannah AVA by the RAD MD who had speculative reservations about Tapered PICCs
Robbin George RN VA-BC
The FDA does not control your practice, legally. They only have control over what the manufacturer can state verbally or in writing about indications for use. There must be significant financial incentives to motivate a manufacturer to go before the FDA to get clearance for a new labeled indication for any drug or device. To support your practice, there are published studies to advise you about how, why and when the off-label use has been done, along with outcomes.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Could I please have some references then to support this?
I have a reference that discusses use of Urokinase......believe it was published in the Journal of Interventional Radiology......but it talks a lot about dialysis catheters, etc.
I would dearly love to be able to quote a published reference that discusses use of tPa to restore proper function of PICCs and other infusion catheters which have persistent withdrawl occlusion.
Can anyone give me info on how to access Patty Luptak's publication?
We have been doing the tPa drip (2mg in 50 ml NS over 2 hr) and successfully resolving this problem at our facility for quite some time. A good track record however isn't enough to satisfy this nurse........I must bring information reflecting standard of care on a broader level..... HELP!
A Kooistra RN CRNOI
Kristin Walker RN, BSN, OCN Maui Memorial Medical Center IV dept.
Kathy Kokotis
Bard Access Systems
I guess I am going to get real basic because I need to ask the original author a few questions to see if we can reduce the issue:
do you use 2mg of drug and not an aliquoted dose or use 1 mg of the 2 mg dose in the line. If you use less than 2 mg you are not using the recommeneded dose that is clinically studied
Do you declot each lumen with the 2 mg dose
Bottom line goal is to get to the fibrin tail
Do you have a policy to flush wiith 10 cc of saline after each drug and at least BID when the line is in use or not in use (Harnage article)
Do you flush with with 20 cc after blood draw, blood administration, and nutritional support or high dextrose concentrations which are thick
These help reduce the occurrence but not eliminate
Kathy
Kathy Kokotis
Bard Access Systems