Does someone have the reference to the article that indicated that clotted or partially clotted catheters have an increased likelihood of causing a CRBSI? Sure would appreciate the link. Any comments on facilities that have a policy of not clearing lines when at least one lumen of a multilumen catheter is functioning and that's all they need at the time? What do you do in your practice?
I can not recall a particular published study that has demonstrated this to be true, however it is generally accepted as a good theory for practice decisions. Fibrin products or complete thrombus will be intermingled with biofilm. There could be many ways that these products can break and shed into the bloodstream, thus increasing the risk of CRBSI. Lynn
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
The docs at our facility will only rarely order a multi-lumen line pulled as long as enough access is available. This has been the routine practice for years, and we have a very low infection rate overall, including this subgroup. It seems that this is an area that needs to be studied so we can all have actual evidence to base our practices on.
At my institution, every occlusion (partial or complete) is treated. It may require rt-PA or catheter removal if unsuccessful with the rt-PA. We use a valved catheter (Groshong) and our occlusion rate (partial and complete is around 8%). However, we sometime have patients transferred with open-ended catheters (Cook) and the occlusion rate is higher for that group of patients (34%). If a partial occlusion keeps happening (even if resolved with rt-PA) we may rewire to replace the catheter. We only do that with open-ended catheters.
Hope this helps.
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA