Bard Access Systems
x-ray all catheters coming into your facility.Â This week one of the hospitals I was at got a PICC line that was placed at another big local hospital by a physcian assistant.Â They thought the x-ray was wierd.Â It was arterial.Â Had they not x-rayed this line they would have used it.
ICU RN's I have learned have no idea what an occluded line is.Â Do you not know that is why you have multi-lumen catheters so if one lumen occludes you tape or tie off the line and write that in the nursing notes.Â In fact the brown lumen which is the end lumen of the acute care CVC occludes first.Â That is the biggest lumen but they draw labs from that alot as it draws fast.Â Than I think it is the white lumen that goes next as the moss crawls uo the catheter.Â Did you know that?Â Thes best part is the RN's told all this right to the infection control director and medical director who looked totally astonished that the ICU RN's left a catheter lumen clotted like a petrie dishÂ Hadaway you need to publish this one in the next article you write for Infection Control Resource
Did you know that Plumer's says to only use 0.5 mg to 1 mg of t-PA in a 3 ml syringe for catheter clearance.Â What is that all about.Â So you transfer the drug to use it safely?Â You contaminate the process.Â Or you use the 3 ml syringe and damage the catheter especially a silicone port.Â Plumer's was updated 2007 eight edition so there is no excuse for this mis-information out there.Â Plus all those authors are those big CRNI's with quite of few of them being past INS presidents.Â Do they review this stuff before just putting out a new edition or what????Â Â Hospitals formualte their policies on info from books like this.Â Maybe they ought to read the ONS Access Guidelines of 2005 as those were updated to reflect a 10 ml syringe and a 2 mg dose of alteplase
Pharmacists do not all understand catheter clearance.Â When treating a catheter according to one of the newest published studies one does not start with 0.5 mg of alteplase in a 5ml syringe and than work our way up to clearance which.Â It is also important to restore blood return in a complete not just partial occlusion.Â Who writes this stuff.Â Believe it or not a large medical teaching institution who never talks to their RN's obviously.
More another day
have a laugh on these.Â It is scary out there.