At my infusion center, some doctors will give an order to infuse non-vescicant chemotherapy through an easily flushed portacath that has no blood return. I am a proponent of Activase when you have tried multiple position changes and saline flushes and cannot get a blood return form a port. I would like to encourage the other nurses to ask for an Activase order rather than just accepting an order to proceed. ( It is our policy to take the needle out and re-access before instilling the activase. ) I have done a literature search for back up information and have found some. I would appreciate hearing if anyone has any other suggested references encourageing the prompt use of Activase when no blood return is obtained (provided there is no contraindication. ) Why wait for it to become completely occluded? why not fix the problem right away?
Thanks,
Penny
when you see this problem of lack of a blood return occurring repeatedly in the same patient, you are probably not dealing with an intraluminal catheter occlusion. More than likely this is due to a fibrin/thrombus inside the vein around the catheter tip. tPA instillation is only reaching the portion of fibrin/thrombus directly at the tip. You treat with tPA and temporarily solve the problem but this is not a total fix. the next time the patient comes in, you have the same problem because the fibrin/thrombus has grown again over the catheter lumen. NO CVAD should ever be used for any infusion without a blood return - with or without a doctors order! That order will never protect you if you infuse a vesicant into the mediastinum or the med flows retrograde and leaks at the venipuncture site, or there is a leak from the port body somehow. Blood return plus patient complaints of discomfort is the only tool you have at bedside to determine that any CVAD is functioning. Quick action with tPA is important because as thrombus ages, it becomes more resistant to lysing. Just be aware that continuing to repeat tPA instillation is not actually solving the problem totally.
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