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Julie Koch
double lumen ELC, aquapheresis cath per CHF Solutions

Currently we use these caths for inpatients for aquapheresis, when the patient does not have the therapy running the cath is flushed with 10ml ns followed by 3 ml heparin 10units/ml every 12 hours. Our physican would like to continue this therapy on an outpatient basis, has anyone had experience with this and if so what does the patient flush their cath with when they are home. I have tried mulitple resources with the company and they have not been informative.

Thanks 

Julie Koch RN, BSN, CCRN 

nursemonica
nursemonica's picture
Which caths?  Are you
Which caths?  Are you talking about a PICC?

 Monica J. Sorg, R.N.

Julie Koch
It is not a picc but an
It is not a picc but an extend length cath that is a midline and use for aquapheresis only. It is made by CHF solutions. 
lynncrni
One additional correction -

One additional correction - these catheters are not in the true midline position of the upper portion of the arm level with the axilla. The tip is placed beyond that position in what was previously called the midclavicular tip location. I am not aware of the current catheter related complications with this tip location for just the pheresis procedure, however I would strongly caution about using this same catheter for infusion of any fluids or medications. This tip location has been associated with higher rates of thrombosis when used for infusion. 

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

Julie Koch
no, it is not a picc but a
no, it is not a picc but a extended length cath that is inserted midline.
lynncrni
This is not a midline

This is not a midline catheter. It is not in the midline tip location. The tip of these catheters are advanced farther into the midclavicular tip location, which is no longer recommended for any infusion. 

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

momdogz
Our cardiology unit does

Our cardiology unit does ultrafiltration with the Aquadex, and CHF Solutions catheters.  We've never sent anyone home with the catheters; that's an interesting proposition.  Are you saying the physician wants to be able to continue aquapheresis in the home?  Or just keep the line in until the next treatment?  

I suppose if you were saving it just for ultrafiltration and not using it for anything else....and the patient's home care was excellent...it might be worth a try.  These patients usually really need ultrafiltration, and if it works - it really helps them a lot.  Lynn's right - they are not PICCs, and they are not labeled for any other use.

FYI:  we've had ongoing difficulty with the dELC clotting off.  CHF Solutions has not been very helpful (they've actually been quite dismissive and patronizing from the start, at least the people we've been working with - when troubleshooting catheter issues with them it's actually come down to, in not so many words, 'if you guys won't place the catheters, we'll find/train someone who will").  The final solution for the dELC - they told us to be sure not to place the dELC catheter past the shoulder.  

I recognize that to decrease risk of clotting the catheter we want the catheter to be as short as possible (without trimming - can't trim these catheters), and that the corner around the shoulder will slow the flow, and that the catheter should be as large as possible to allow for good flow, etc. etc. etc.....it's a really difficult situation.  For many patients it's not apropriate to place a 6 french catheter, so we'll use the single lumen and have to start another peripheral for the return.  

We've been in regular contact with Michael Drafz about his experience - pretty much the same as ours.  Also with Dartmouth - they are using IJ dialysis catheters.  I don't think there is a great solution as far as the catheter goes.

I'd love your feedback on your experience with both the dELC and the single lumen 35cm catheter.

 

 

 

 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Julie Koch
Mari, Thank you so
Mari, Thank you so much.......... I have had the same feedback from the company regarding the cath. (no it just not you). We are in the midwest (Mercy in Des Moines), and I have an RN that came from Neb. and she has not heard of this. I have to keep correcting the rep and telling him that it is not a PICC, but an extended cath and he should provide the information how to take care of the cath when therapy is not running. He tells me that other people are using their ELC on an outpatient basis but will not provide me with names or resources. I have even spoken with the Clinical RN rep. and she has never gotten back to me. The frustration that I have is, that I was the clinical educator in CCU and help set up the aquaphersis program several years ago and now I am the manager of the PICC team. We have never inserted the cath past the shoulder. I am having difficulty having the RN staff in the hospital understanding that it is not a PICC and can not be treated as such, ie. infusions. We have always continued the use of heparin for this therapy and with flush in the inpatient population. You are correct in that the physician would like to send the patient home with the cath only to come in as an outpatient for the therapy. The cath will be used for the therapy only. They would like to have the patient come in every other day in the CHF clinic and have a therapy treatment. I am curious is Michael Drafz at Darmouth? Our PICC RN's insert the ELC, for the therapy, the physicians do not want to insert CVC's for various reasons. I do believe that the therapy is a great alternative for the CHF patients, thanks for the support. Julie Koch
momdogz
wow - your experience with

wow - your experience with the company sounds really familiar.  I'm sorry to hear that.  I gave up, eventually.  Good for you for being adamantly clear about the catheter not being a PICC.  When I tried to discuss the problems of the catheter tip location with our clinical rep, she was very impatient, dismissive, and patronizing.

I totally understand MDs not wanting to put CVCs in for this; part of the beauty of the therapy is that it's minimally invasive (besides being a life-saver for people who have failed diuretics).  I've even researched other catheters.  We (PICC RNs) put the catheters in, too.

Michael Drafz works in San Diego.  At one time he was going to move to NY, but I'm not sure that he did.  Did you read his article in JAVA?

I don't usually recommend sending patient's home with catheters in a midline location, but if this a last resort for a patient and they were going to be followed closely, I could see why the MD would want to try it.  If you go ahead with it, let me know how it goes.

[email protected] 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

lynncrni
Mari, I wish you would

Mari, I wish you would publish your experiences and outcomes with this midclavicular tip location. To me, this discussion highlights the same problems we have always seen with midclavicular location - vein irritation probably from a mechanical cause leading to vein thrombosis. Have you ever been able to get a US on these catheter tips to see what was happening? When the patient goes home, do you retract it to a midline location or put in a new catheter at the midline location? It seems like we need a lot more data on outcomes with this procedure and catheter. 

 

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

momdogz
I'd like to publish, Lynn. 

I'd like to publish, Lynn.  We haven't sent anyone home with these lines, but have been keeping track of those we've done in inpt cardiology.  We haven't evaluated with U/S - thanks for the prompt; we'll start doing that and adding to our data.

We've ended up preferring the 35 cm single lumen catheter most of the time, and trying to place it as high up the arm as comfortable/safe/reasonable so that we're NOT in midclavicular position, but deeper.  We hate leaving catheter tips in that area.  Our experience with the dELC and the ELC (the single) and the company has been more than frustrating....though the fluid removal helps the patients significantly, it would be MUCH better if we weren't adding to the patient's co-morbidities in the process.

We definitely need more data - from multiple facilities.  Michael D. and I talked about pulling a presentation together about our experiences - sounds like we could gather info from several hospitals.

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Karen Day
Karen Day's picture
hi guys.  I was reading

hi guys.  I was reading this thread and went to the CHF solutions website and can not find any information about the specific catheter you mention here.  Does CHF solutions make the catheter or are you using a midline catheter that is manufactured by one of our well-known picc companies. 

I am not very familiar with this procedure, but would like to learn more so that I may inquire about it with our cardiology group.  We currently do not do this procedure here, but we have a very large cardiology group and if this is something they may be thinking about, I as the picc team leader would like to assist them with it. 

Other than CFH solutions, is there any other websites where I can find more information about this procedure and the risks, benefits how and where performed, published studies etc. 

I really appreciate your help. 

momdogz
Hi, Karen: CHF Solutions

Hi, Karen:

CHF Solutions does indeed market the catheter.  I can get you the papers from the FDA about the catheter, and other information the company has sent to me.

Also - use your AVA membership to find Michael Drafz's article in JAVA - I think it was December 2007, but I don't have it right in front of me.   The article is about Ultrafiltration.  It will be a big help.

email me and I'll send you everything I have.

Mari 

[email protected] 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Lauren Blough
We are embarking on the

We are embarking on the CHF therapy as well and finding the same adventures as i see here!  We would prefer not to use their catheter due to the stated reasons. We are trialing the Arrow Dual lumen peripheral. Have only used on one patient. has anyone trialed this type of device??

 

Lauren Blough, RN, BS, CRNI

VAS Clinical Specialist, Florida Hospital, Orlando, FL

momdogz
Lauren - I love how you

Lauren - I love how you described starting this process as adventure.....

 

For the folks using the Arrow DL peripheral - keep us posted about how well it works.

Do you have any problems with the system clotting off?

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Carol Gonzales
We just started using this

We just started using this catheter a few months ago. We are only using it on inpatients in the critical care areas. The catheter can only dwell for a maximum of 5 days but is usually removed after the 2nd or third day. If the patient needs access for other reasons at that point, it can be converted to a PICC with a guidewire exchange procedure. If not, it is removed before the patient is transferred out of the ICU.

I am wondering if anyone is consenting the patient for the procedure and the catheter placement. If so, is the catheter placement considered a part of the procedure consent or is there a separate consent for the catheter.

 Also, what type of draping are you using for device placement (full body or regular fenestrated drapes)?

James M Joseph
James M. Joseph RN , BSN,

James M. Joseph RN , BSN, CRNI

We have been placing the dual lumen 20cm catheter for peripheral UF  and are currently adding the 15cm catheter with internal coil to our choice of catheters.

The lines  are labelled "UF ONLY". An order set for cae and maintenance is placed for the nurses along with the flush and DWELL protocol. Dwell means pack or what we use to ensure catheter patency when the therapy is stopped for any length of time.

We are going to send patients home with the catheter in place and bring them back as outpatients for the short duration of therapy. Patients may also arrive directly from doctor's offices for catheter placement and therapy.

We have a database in place and would be interested in hearing from other institutions interested in sharing data on a national level.

The idea and practice of Peripheral UF is fairly new but has had some very good patient outcomes. This a great opportunity for all of us.

 

 

 

James M. Joseph MPH, RN , BSN, CRNI, VA-BC

 

momdogz
Would love to capture/share

Would love to capture/share data with your group.  

[email protected]

 

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

MarkCVL
FYI....This will be a
FYI....This will be a presented topic at the 2009 AVA Scientific Meeting in Las Vegas, Sept. 15-17!  Hope to see you there!
momdogz
who is presenting?  Mari

who is presenting? 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

MarkCVL
Michael Drafz will be the
Michael Drafz will be the speaker.  If you have specific questions that you wish him to address...I will be glad to foreward.  Just post your questions on this thread and I will call it to Michaels attention.
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