I am wondering how other places are dealing with "blood return from each lumen every time" with their PICC's. We use an open-ended PICC catheter and CLC 2000. We stopped using heparin flush about 8 weeks ago, great for the patient but we are working ourselves to death no only using Cath-flo for occlusions, but for blood return from every lumen every time. We are a small department that basically has more that enough to do with PICC insertions and all that entails. I was wondering what the group thinks about training med/surg staff and critical care staff to use Cath-flo, ..I know not ideal, but something has to give and I'm trying to figure out what...We have had education to staff about good flushing techniques, etc til blue in the face and have about decided if "its not their problem, and they can call someone to fix it", there will never be great compliance...Any comments?
Angela,
I suppose you already may have thought of this but; are you sure that the staff is flushing, disconecting and then clamping (if you clamp)?
I have seen many places were the after years of flushing, clamping then disconecting, the new process is hard to adapt to.
Do you flush wiht 20cc after each blood draw? this also has been shown to help.
Mike Brazunas RN
Clinical Specialist
AngioDynamics
Hey guys,
since it has been brought up, lets talk about flushing. We used to teach our staff to either not clamp or clamp after disconnection like Mike mentioned. We find it is dependent on your cap however, when and if you need to clamp your line. We have since changed our end caps twice and are looking at possibly changing again. We first had a positive pressure cap, then a neutral, now a negative. The re-education each time we change a cap is getting frustrating to us and the staff. Is there not a standard way to flush regardless of what type of cap you have - I am thinking that maybe positive pressure flushing should always be used (I just am fearful that if a clamp becomes undone accidently between uses, you could end up with an occlusion in those instances). Our facility has been kind enough to include is in the decision making of the choice of end caps, however, our choice is not always picked and I don't think any VAD team in any facility will always win this neverending battle of which cap to choose and how to best educate the staff. Thanks for your help
Sorry but to have a standardized method for flushing, one that does not matter about clamping sequence, you must stick with one that is a neutral displacement. A negative displacement connector incorporates clamping into the flushing sequence before you disconnect the syringe. Clamping a positive displacement device is possible but **only** after you have disconnected the syringe.
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
Lynn,
that's what I thought. I just wanted to see if I was thinking correctly. It is difficult to teach this, especially to all of the home health agencies that inquire about flushing - when we ask them what kind of end cap they have, they don't even know! We have demonstrated negative reflux with caps and clamping sequences to show them how to best tell what type of cap they have, but it still seems to be a difficulat concept for all fo the facilities to grasp. If you have a positive pressure cap and you clamp prior to disconnecting, am I correct in stating that you basically negate the effect of the cap?
Yes, you are correct about clamping a positive displacement connector prior to disconnection. The closed clamp prevents the positive displacement from occurring.
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
Linda Lembo CRNI
Valley Hospital
Ridgewood, New Jersey
This is in response to the Cathflo issue. Every nurse in our hospital is capable of instilling cathflo for lack of blood return. We have standing pre printed orders that need to be activated by an NP or MD. As far as declotting with the stop cock we have resource nurses trained for that purpose.
Linda Lembo CRNI
Valley Hospital
Ridgewood, New Jersey
tell me one more thing Lynn, if you are using the PASV or Solo technology with the valve built into the picc line and you have a negative pressure endcap, whats the best flushing technique for this? We thought we had heard somewher that these types of caps should not be use with this type of catheter. Thanks again.
You can use all brands and types of needlleless connectors on a PASV. I am confused about what you can put on a Solo because what is in their instructions is not what others are saying on this list. So you will need to check with Bard Access and request their written statement about this.
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