Forum topic

16 posts / 0 new
Last post
Jane Whiteaker
Clotted Bard Solo PICC Lines

I work at a community hospital, we insert about 80 - 100 PICC lines per month. We've always used BARD products and started using the Solos about 6 months ago. About the same time we started using them, we also started using Baxter V-Link Vitashield (antimicrobial caps). Since then we have had approximately a 15% increase in clotting of the PICC lines; often even Cathflo won't unclot the lines. Is this coincidental - is it poor flushing technique or is it the caps?

Robbin George
One offending component may
One offending component may be the Baxter end cap which I believe is "Negative" displacement--The Solo literature specifically says NOT to use such a product with its Integral Valve technology

Robbin George RN VA-BC

Mary Spiering
I work in a University

I work in a University Hospital setting and our PICC Team recently trialed the Bard Solo PICC. Of the 946 PICCs placed between May, 2008 and November, 2008, our total de-clot procedure rate was 11%.

Breakdown of PICC lines (total number reviewed):

Power = 97  Solo = 107  Groshong = 766

Declot rates:

Power = 24%  Solo = 27% Groshong = 6%

Historically, our Power PICCs have had a higher de-clot rate but the Solo PICCs are even higher. We use the Max-Plus clear valves but our flushing protocols are not on the MAR. 

No matter what the catheter, the design needs to be simple enough to allow for the bed-side nurse to access multiple times without having to think about what type of valve to use or how many times to flush with which type of fluid. Although the Power PICCs serve a need, in our institution they increase patient cost and nursing time through multiple de-clot procedures with TPA.

We plan to complete another trial after January or when Bard comes out with a different Solo PICC design. Stay Tuned....

pamhodges
Do you all like the Max-Plus
Do you all like the Max-Plus Clear Valves? We are looking to switch to them soon. My understanding is that the central line will not have to be heparinzied. Am I on the right track with my thinking???
lynncrni
You can approach this from 2

You can approach this from 2 directions. You can rely on what the manufacturer's written instructions for use say about saline-only flushing. Or look at the limited amount of published research on this issue. To my knowledge there is only one small study comparing saline only vs saline and heparin in a positive displacement needleless connector. They found a 6% rate of occlusion, which was not statistically significant,however it was enough of a financial hit to cause that facility to stay with saline and heparin. This was a randomized study, although a small sample size.

1.    Bowers L, Speroni K, Jones L, Atherton M. Comparison of occlusion rates by flushing solutions for peripherally inserted central catheters with positive pressure luer-activated devices. Journal of Infusion Nursing. 2008;31(1):22-27.
 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

amaguila2009
Would you mind telling me
Would you mind telling me how you collected this information re: occlusion rates?
Jane Whiteaker
Floor nurses calling because
Floor nurses calling because they are unable to withdraw blood. Compared the number of clotted PICCs to the number we inserted - compared to the same time last year. The clotted PICCs seem to be mostly in the Med/Surg and telemetry units. Not much in the ICU. We are going to be performing an in-service with our BARD representative on Monday and Tuesday to reinforce correct flushing technique. Right now we're trying to eliminate poor flushing technique and the different connectors before making a determination whether the clotting is related to the PowerPicc Solo.
bartina
Nancy Rose RN IV Team VA

Nancy Rose RN IV Team VA Medical Center Wilmington, DE (800) 461-8262 ext 4830

Are the declot rates for total or partial withdraw occlusions or both? We currently use BARD (often double lumen) groshongs. Most of our PICC Alteplase treatment is for partial withdraw occlusions of the proximal lumen.

We are going to trial BARD power PICCs next week. Thanks for the posts about the SOLO.

 

 

Nancy Rose 

plsysinc
To my knowledge the solo
To my knowledge the solo Picc is not to be used with a negative reflux connector and the V-Link is a negative reflux connector.  The V- Link is supposed to be used with Positive Pressure or Neutral.
Mary Spiering
 I did not distinguish

 I did not distinguish which lumen required TPA or if partial versus total, but will try to include in further data collection. Thank you for indicating your issue with the proximal port, will be interesting to find out if we have the same issue.

We collect our overall de-clot procedure rates from our billing data and noted an increasing trend when we started using Power-PICCs so took a more in-depth look by reviewing our PICC kardex. The IV Therapy Team records TPA use on a Kardex kept in the IV Therapy office. Eventually, will be able to obtain this info off the electronic medical record.

 

amaguila2009
Mary, Does your team make

Mary,

Does your team make rounds on your PICCs everyday? This is great that you can monitor your PICCs that closely.

Mary Spiering
Our team does not make

Our team does not make daily rounds on each PICC but they do all the dressing changes and respond to the majority of the PICC issues such as clotting, leaking (repair), and any other consultation needs.

bartina
Nancy Rose RN IV Team VA

Nancy Rose RN IV Team VA Medical Center Wilmington, DE (800) 461-8262 ext 4830

We make rounds on our PICCs the five days a week that we (that is two of us) are here. We log our inpt Alteplase administrations what type of line and which lumen, successful or not. We haven't calculated our rates though.

We are having a problem with "short" port tip placement. There seems to be a direct correlation with need for Alteplase and proximal SVC tip placement. I have approached the surgeon with literature supporting short tip placement and failed ports. He agreed to "make them longer" but seems to have had a relapse. Anyone else out there encountering this?

 

 

 

 

Nancy Rose 

afruitloop
Regarding the port and a

Regarding the port and a high SVC tip.....

When these lines are pressure injectable, they "move" when the injection occurs--wiggle, pull back on themselves, twirl, etc.  IF you have a port (or a PICC, or a tunneled or a percutaneous CVC) and the tip is high in the SVC, there is a possbilibity that the tip will actually migrate out of the SVC into the brachiocephalic vein.  The reason I know is because I have seen it happen.

I believe this it the rationale for verifying the location of the tip of many of these lines before pressure injecting them.

 

Cheryl Kelley RN BSN, VA-BC

lynncrni
This is true for any CVC

This is true for any CVC with a tip located high in the SVC. Any pressure change can cause tip migration into the jugular or contralateral subclavian. Coughing, vomitting, ventilators, heavy lifting, congestive heart failure are all causes of changing intrathoracic pressure that has been documented to cause catheter tip migration. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

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

Pamela Zuchowski
My hospital places 60-70

My hospital places 60-70 PICCs per month. We had a huge increase in clotting problems after switching to a positive flow valve approx 1 1/2 years ago. We are now switching to a neutral valve called the Invision-Plus, made by RyMed Technologies. I was impressed with this product for many reasons and hope it will reduce our clotted catheters. You can look them up on the internet and get information.

Log in or register to post comments