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.
ThanksÂ
Julie Koch RN, BSN, CCRNÂ
Monica J. Sorg, R.N.
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
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
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
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
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
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
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
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
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
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.
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
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
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
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
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
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 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
Would love to capture/share data with your group.
[email protected]
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
who is presenting?
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center