I work at a community hospital, we insert about 80 - 100 PICC lines per month. We've always used BARD products and started using the Solos about 6 months ago. About the same time we started using them, we also started using Baxter V-Link Vitashield (antimicrobial caps). Since then we have had approximately a 15% increase in clotting of the PICC lines; often even Cathflo won't unclot the lines. Is this coincidental - is it poor flushing technique or is it the caps?
Robbin George RN VA-BC
I work in a University Hospital setting and our PICC Team recently trialed the Bard Solo PICC. Of the 946 PICCs placed between May, 2008 and November, 2008, our total de-clot procedure rate was 11%.
Breakdown of PICC lines (total number reviewed):
Power = 97 Solo = 107 Groshong = 766
Declot rates:
Power = 24% Solo = 27% Groshong = 6%
Historically, our Power PICCs have had a higher de-clot rate but the Solo PICCs are even higher. We use the Max-Plus clear valves but our flushing protocols are not on the MAR.
No matter what the catheter, the design needs to be simple enough to allow for the bed-side nurse to access multiple times without having to think about what type of valve to use or how many times to flush with which type of fluid. Although the Power PICCs serve a need, in our institution they increase patient cost and nursing time through multiple de-clot procedures with TPA.
We plan to complete another trial after January or when Bard comes out with a different Solo PICC design. Stay Tuned....
You can approach this from 2 directions. You can rely on what the manufacturer's written instructions for use say about saline-only flushing. Or look at the limited amount of published research on this issue. To my knowledge there is only one small study comparing saline only vs saline and heparin in a positive displacement needleless connector. They found a 6% rate of occlusion, which was not statistically significant,however it was enough of a financial hit to cause that facility to stay with saline and heparin. This was a randomized study, although a small sample size.
1. Bowers L, Speroni K, Jones L, Atherton M. Comparison of occlusion rates by flushing solutions for peripherally inserted central catheters with positive pressure luer-activated devices. Journal of Infusion Nursing. 2008;31(1):22-27.
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
Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]
Nancy Rose RN IV Team VA Medical Center Wilmington, DE (800) 461-8262 ext 4830
Are the declot rates for total or partial withdraw occlusions or both? We currently use BARD (often double lumen) groshongs. Most of our PICC Alteplase treatment is for partial withdraw occlusions of the proximal lumen.
We are going to trial BARD power PICCs next week. Thanks for the posts about the SOLO.
Nancy Rose
I did not distinguish which lumen required TPA or if partial versus total, but will try to include in further data collection. Thank you for indicating your issue with the proximal port, will be interesting to find out if we have the same issue.
We collect our overall de-clot procedure rates from our billing data and noted an increasing trend when we started using Power-PICCs so took a more in-depth look by reviewing our PICC kardex. The IV Therapy Team records TPA use on a Kardex kept in the IV Therapy office. Eventually, will be able to obtain this info off the electronic medical record.
Mary,
Does your team make rounds on your PICCs everyday? This is great that you can monitor your PICCs that closely.
Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]
Our team does not make daily rounds on each PICC but they do all the dressing changes and respond to the majority of the PICC issues such as clotting, leaking (repair), and any other consultation needs.
Nancy Rose RN IV Team VA Medical Center Wilmington, DE (800) 461-8262 ext 4830
We make rounds on our PICCs the five days a week that we (that is two of us) are here. We log our inpt Alteplase administrations what type of line and which lumen, successful or not. We haven't calculated our rates though.
We are having a problem with "short" port tip placement. There seems to be a direct correlation with need for Alteplase and proximal SVC tip placement. I have approached the surgeon with literature supporting short tip placement and failed ports. He agreed to "make them longer" but seems to have had a relapse. Anyone else out there encountering this?
Nancy Rose
Regarding the port and a high SVC tip.....
When these lines are pressure injectable, they "move" when the injection occurs--wiggle, pull back on themselves, twirl, etc. IF you have a port (or a PICC, or a tunneled or a percutaneous CVC) and the tip is high in the SVC, there is a possbilibity that the tip will actually migrate out of the SVC into the brachiocephalic vein. The reason I know is because I have seen it happen.
I believe this it the rationale for verifying the location of the tip of many of these lines before pressure injecting them.
Cheryl Kelley RN BSN, VA-BC
This is true for any CVC with a tip located high in the SVC. Any pressure change can cause tip migration into the jugular or contralateral subclavian. Coughing, vomitting, ventilators, heavy lifting, congestive heart failure are all causes of changing intrathoracic pressure that has been documented to cause catheter tip migration.
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
My hospital places 60-70 PICCs per month. We had a huge increase in clotting problems after switching to a positive flow valve approx 1 1/2 years ago. We are now switching to a neutral valve called the Invision-Plus, made by RyMed Technologies. I was impressed with this product for many reasons and hope it will reduce our clotted catheters. You can look them up on the internet and get information.