I am now being approached by our Pharmacy as a way of conserving money about the use of Cathflo 1mg per lumen dosing instead of 2mg per lumen. Of coures since the vial comes in 2mg if I am only treating one line I can give the full 2mg as not to waste but.......if I am treating 2 lumens then dilute and divide so each lumen only gets 1 mg. they say they have studies that say it is effective and I have asked to see them.
I researched this topic on this listserve and found discussion from 5 years ago and wonder if any new info as risen on this subject.
I have discussed with the pharmacy my concerns; giving a lower than recommended dose may cause me to actually have to repeat more steps /doses and end up taking longer for me to get the occlusion resolved if this is not effective.
I do not like going against manufacture recommendations although I know many do in many situations with medication to individualize it to the specific pt need.
They have tried asking me to use less Cathflo but I tell them, I only use it when it is indicated. I do not feel like it is optional when indications arise. Apparently many of our sister HCA facilities are not even using Cathflo for occlusions and go right to Guidewire exchanges??????? Where is the sense in that?? So there practice has made my facility look like a high volume user.
Please share if you have any recent experience with this dose.
Gina Ward R.N.
I would not accept their statement unless they share the published evidence with you. Of course, they may be able to do that. I have not done a lit search on this issue. I would also want to do my own lit search to find these articles. You should evaluate the quality of their publications and then make your decision. 2 mg in 2 mL will result in a majority of the volume being infused into the vein and not dwelling inside the lumen. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Perhaps instead of reducing your CathFLo dosage, you might consider trying to reduce the number of occlusions. A no cost way to do this may be to revise/reviwe and reeducate on your flushing policy. You may be assuming nurses are flushing properly per your policy, but perhaps after time the habit changes. You would be surprised, I find at many hospitals that staff/floor nurses do not flush with all 10mL NS< they use the same syringe for 5 before and 5 after. Not only inadequate but high risk for infection. You may also want to review your policy to use 10mL each time, with a push/pause flush if you don't have that as part of your policy now. You may also want to consider using heparin if you don't currently, at least on those sluggish lines, or those treated once with Cath Flo, and other high risk pts (oncology, non mobile, etc. )
Another no cost thing to do is be sure all staff understand how/when to clamp after flusing, depending on the connector you use. If your needleless connector is not truely neutral, improper clamping can make a big difference in occlusions.
There is better technology available to avoid occlusions as well, new PICCs with antithromboic treatments, connectors that are truly Neutral and eliminate reflux, thus reducing occlusions. This technology may be available to you, check with your purchasing department, as new products are added to hospital contracts all the time.
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
Consider 125 beds of which 24 are ICU. Current use is 80 doses of cathflo per month. At this time the facility uses a valved Bard Power Picc with Baxter One Link Neutral Displacement connectors. Per current policy, dual lumens are placed on nursing floors and triple lumens are placed in ICU. The patient diagnosis is widely varied, lots of pneumonia/sepsis/osteomyelitis, not too many cancer patients. Changes are planned for this program! After changes, with these beds and this patient population, what would represent a reasonable monthly usage of Cathflo?
Wow Jill, there is so much wrong with this scenario, I am hoping it is not a real situation! First and foremost - lumen occlusion is a complication that requires interventions to prevent it and to keep it to as low as possible. I have not looked at the literature and I doubt you would find an answser to the question about what is "excessive". In my opinion, this is definnitely excessive and in serious need of a QI initiative to decrease this rate.
I don't know of any standards, guidelines, or recommendations that lists the patient's unit as an acceptable criteria for choosing the number of lumens in any catheter. This should be chosen based on patient need. More lumens to manage equals a greater risk of CRBSI - documented in the literature. If the choice can be justified based on patient need, then it is acceptable. But if the patient does not need all those lumens, the risk is unacceptable. More lumens = larger outer diameter which also increases risk of vein thrombosis. Where is the tip location? Is there evidence of tip migration? All of this increases risk of thrombosis. We are seeing a greater amount of evidence linking thrombosis to infection, so what decreases thrombosis could easily increase infection. And the hospital is not getting paid for these hospital acquired infections! Finally unnecessary lumens requires more nursing time to maintain them. This could be a large part of the problem as nursing staff may not be paying any attention to the unused lumens. I have seen many lawsuits where an inapprporate number of lumens was chosen and I always list it as a deviations from the standard of care.
The goal for all complicatios is zero! While that may not always be achievable, I would say there is much that could and should be done to reduce this number of occlusions. For any occlusion, we assume we are treating an intraluminal thrombosis, but you could actually be treating a vein thrombosis at or near the catheter tip. So again, the goal is as low as you can drive it down. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
This is a real situation, but it's changing! I was trying to find a reasonable attainable goal. Eventually we can head for zero.
The guidewire exchanges Gina talked about are scary also. I'm more and more convinced each day that PICC inserters should be credentialed.
The Joint commission already requires each facility to have documented competency for each person in their facility. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861