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Linda_Tirabassi
able to aspirate blood but not able to flush?

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

lynncrni
Debris in lumen probably drug

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, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Linda_Tirabassi
Response to Debris in the lumen

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. 

lynncrni
Drug precipitate is due to a

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, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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