Has any one used agents other than t-PA to remove precipitates from central lines? I have a TPN pt who has difficulty flushing her port after the TPN cycle is complete but has brisk blood return. Any one have a P&P for use of other agents?
Has any one used agents other than t-PA to remove precipitates from central lines? I have a TPN pt who has difficulty flushing her port after the TPN cycle is complete but has brisk blood return. Any one have a P&P for use of other agents?
This may or may not be something that can be cleared by instilling other agents. It could be a mechanical occlusion. Do you get a blood return before PN infusion also? Does the blood return change with a different arm postion? Is this catheter inserted into the subclavian or jugular vein? If subclavian and it changes with arm position, it could be pinch-off syndrome. This requires an xray to determine if it is happening.
It could also be lipid sludge if there is fat emulsion included with the PN, especially if this is a 3-in-1 solution. That is cleared by ethanol. Lots of literature published on this. Sorry no p&p to share. Lynn
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
Thank you Lynn. I feel it is lipid sludge because there is always good blood return without changing arm position. The blood return is why the MD does not want to cath-flo until that is an issue. This pt is going out of state the end of the month for a few weeks and is concerned she might have issues when gone. I was just looking for something to help and ease her mind. Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
Cath-flo will have no effect on lipid sludge. Is this a polyurethane or silicone catheter? Ethanol could be a problem instilled into some polyurethane catheters but should be no problem in some of the newer ones and silicone. Lynn
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
Hi Lynn,
So would you say that for silicone catheters ethanol does not risk causing damage? For how long would you let ethanol dwell in a silicone catheter?
How will I know if a patient's PU catheter can stand ethanol?
Mats in Stockholm
There is no published evidence of damage to silicone from ethanol. We have used ethanol from ~30 years to eliminate lipid sludge with ethanol locks. There is some newer evidence that ethanol can be used to treat CRBSI with good results. Dwell time for lipid sludge is about 2 hours. I can't remember the time for treating BSI. The only way to know if a PU catheter can tolerate exposure to ethanol for locking purposes is to contact the manufacturer and ask for written information. Lynn
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
We have a couple of clients who are successfully instilling ethanol 70% q am post PN-administration on a daily basis, for infection prophylaxis but there are studies showing the ethanol's efficacy with occlusion treatment and prevention, as Lynn indicated. I'd be happy to send you the protocol for formulation of the solution and suppporting references. You can contact me @ dbroadhurst[at]oms[dot]ca.
Daphne Broadhurst RN
Infusion Nurse Consultant
Desjardins Pharmacy
Ottawa Canada
Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada