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Extension sets and clotting

Does anyone have references that address the use of excessive tubing/extension sets/Y sets/etc, and clotting problems?

I'm aware of the mechanical valve, positive/negative displacement devices issues, but I have staff that adds extra tubing that I think (and can't prove yet!) is causing clotting in the PICCs. There is no need to connect a Y heplock to a dual lumen PICC then only use one port for the single infusion the patient is getting.

 Right now, we are using the Vaxcel BSI product, and the PASV doesn't seem to prevent the clotting. We also use the BD flushes, which are supposed to address the 'plunger' issue when flushing.

Lastly, how does everyone like the Q-syte?

Thanks for your input.

Bud Lavin

Manager - Vascular Access Services

St. Mary's Passaic

Are you using the Vaxcel

Are you using the Vaxcel with or without the PASV? If you are using Vaxcel with PASV, and the nurses are closing a clamp between the valve in the hub and the patient, this is preventing the valve from functioning as it should. Clamps on the external side of the valve are ok. 

What is the incident rates of your clotting problems? Are you sure that you are actually dealing with intraluminal clotting or the multiple types of vein thrombosis that occurs inside the vein around the catheter? The approach to prevent and treat would be different for each type. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Lynn:  Thanks for the


 Thanks for the reply. sorry for my delay in respionding. things have been quite hectic here getting the program up and running.

We were using the PASV Vaxcel catheters. There are no clamps between the internal tip of the catheter and the PASV.

 What I have been able to determine, it seems to be intralumenal clotting. many times it occurs within the first 24-48hrs, but sometimes later. I'm beginning to think that it is truely an education issue, for the most part. I also have noticed that sometimes, it is the same patients, so some can possibly be causes within the patient, coupled with poor practices, making things difficult.

Since doing more Bard Poly-Per-Q-Caths, I've experiened less problems. And the ones I've had, definately were 'operator error'. Everything from drawing blood thru Clave caps and not flushing/changing them to finding blood in the clear part of the external catheters, make me think I have some serious education to do here.

 We plan on switching to the Q-Stye caps in the very near future (for both the infection issue and the ability to see blood in them). I hope that helps somewhat. If staff sees the blood in the cap, maybe they'll change it more freqently than the Clave.

 Thanks again for the advice.



Bud Lavin, RN, CEN

Manager - PICC Team

St. Mary's Hospital

Passaic NJ


The Q-Syte has a large
The Q-Syte has a large reflux with disconnection.  When using an extension, you would need to clamp before removing the syringe or tubing and then with connection reverse the procedure by applying pressure to the syringe barrel before opening the clamp.  The q-syte Has a large priming volume and it is the displacement of the syringe luer with connection that sets up the reflux.  Any blood that is between the endo of the slip tip and the septum will not be able to be flushed.  So you will see blood in the Q-Syte that can not be removed with flushing. 
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