I have a patient problem with a 7FR double lumen Hickman. He is on IV fluids only. His red lumen if fully functional; his white lumen is the reverse of the usual partial occlusion, I am able to aspirate blood but not able to flush. The white lumen has not responded to cathflo x3; CXR shows the tip at the atrial caval junction, same as when it was placed March 2019.
Have others encountered similar problems? Any feedback/thoughts for etiology of this problem or interventions are appreciated.
Thank you.
Linda Tirabassi RN MN CNS
Debris in lumen probably drug precipitation is being pulled against catheter wall when you aspirate allowing blood return. When you inject this is closing and occluding lumen. Seen it happen with implanted ports bit not with a regular catheter.
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 attempted another dose of Cathflo without success. I don't feel I can instill other agents without connecting it to a specific drug interaction. I have used HCL and ETOH the past with success, but the history was obvious. He is an ONC patient and I honestly don't know all the drug history in the past, but most recently her was getting IVF w/ a few additives, no calcium,, no triple mix, etc. Very frsutrating, I appreciate your response.
Linda Tirabassi PhD RN CNS CPNP
Drug precipitate is due to a change in pH. To reverse the precipitate, you have to know the pH of the drug that precipitated. Low pH drugs are reversed with hydrochloric acid. High pH drugs are reversed with sodium bicarbonate. To know which one to use, you have to carefully assess history of what went through lumen within a few hours before it occurred.
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