Our hospital is trying to reduce the occurence of PICC occlusions. One unit, who has had a very high occlusion rate in the past, has started hanging a KVO at 20ml/hr when patients are receiving a Morphine drip. Their occlusion rate has been zero for several months now. Is there any literature to support this practice? Is any other hospital using a practice similar to this? Also, could this be applied to a PICC that has several intermittent medications infusing, to help limit the amount of times you manipulate the catheter hub to flush before and after each medication with saline? We are aware that this method could not be used for any patient on restricted fluids.
There is no science that has ever established that XX rate will keep a catheter or vein "open". So there is no such thing as a KVO rate. Are you talking about morphine infusion through a short peripheral catherter or PICC? I would guess that your occlusion rates are related to the flushing/clamping technique in use being the wrong one for the needleless connector in use.
Negative displacement needleless connector = positive pressure flushing technique and clamping BEFORE disconnection
Positive displacement needleless connector = no positive pressure flushing technique and clamping AFTER disconnection
Neutral displacement needleless connector = no difference in flushing or clamping technique, can be done before or after disconnection
I am sure the positive pressure from your infusion pump is what is keeping the lines open and not any magic flow rate. This pump, fluid and extra tubing adds costs and could interfere with patient mobility. Proper flushing and clamping will accomplish the same thing. 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
I don't think it is related to flushing or the type of end cap. This is a continuous infusion and it doesn't get flushed because the Morphine is infusing through it. When the Morphine was running alone, the PICC was occluding. With the addition of extra fluid infusion we have stopped the occlusions.
Was there any other meds being given through the same line? Do you think this could be a drug precipitate? What type of catheter? PIV or CVC? MS is very irritating, so there could be vein irritation causing this occlusion, totally inside the vein and outside the catheter lumen. If that is what is happening, dilution of the MS with more fluids could be reducing this irritation and thrombus formation. Just a few more thoughts, 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
I was getting ready to send a question that had been posed to me by the hospital, r/t running Zosyn with a bag of saline running at KVO of 20ml/hr. I had told them what we do in the home, which does not include running extra fluids for slow continuous rates. I saw this thread and shared it with the person asking me. She posed the following to Lynn or anyone:
Ann, I just wondered if they had any trouble with peripheral iv sites occluding or clotting off when they ran an infusion at a very slow rate with no other fluids running. The only time I’ve seen it is if they have had intermittent infusions of antibiotics. The flushing of the lines was not an issue, they were clotting off while the antibiotics were infusing. Thanks again for your help. Jennifer
Thanks!
ann
I have infused thousands of intermittent meds directly connected to all types of peripheral and central catheters and never had this problem. 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