Forum topic

13 posts / 0 new
Last post
Mary Kreinbucher RN
List of PICC catheters/Midline catheters

Hello everyone!

 

Is there anyone who has created a list of PICC/Midline catheter sizes, per company with ispecs ( size length, diameter volume)  to utilize when a patient presents in the EOR and the line needs declotted.  Oftentimes there is no information about the size of this line.  If the Activase product to be used  states 110% of the internal volume as it's prefereable dose, and you do not have any idea what that is ( do not have packaging) then a reference will be helpful.

 

Any other ideas you are using to deal with this problem?

 

Mary

lynncrni
 Maybe but maybe not. Most

 Maybe but maybe not. Most catheters are trimmed to a paitent specific length. This alters what the manufacturer lists as the internal or priming volume for the entire length of catheter. You would then need to apply a formula for determining the exact internal volume for the length of catheter in the patient but it would requrie that you also know that exact length. And that data does not usually follow the patient. So you are back to the beginning. That is why most policy and procedures call for using the 2 mg in 2 mL rather than trying to use the 110%. Lynn

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

Carole Fuseck
Mary, in addition to Lynn's

Mary, in addition to Lynn's comments, I add a gentle reminder that you used "midline" in your question.  CathFlo is for central venous access devices only.  A midline is not a central line.

Carole

kejeemdnd
Out of curiosity

Aside from the specific drug indication, what would be the harm in thrombolysing a midline, especially if you really wanted to save that line?

A couple thoughts occurred to me: 1) I have worked at 2 facilities now that use a catheter marketed as a PICC line (a CVAD) that is trimmed to the axilla to get a midline; and 2) Physicians will often use a drug off label if they have reason to believe the benefit would outweigh the risk.

I'm not challenging your statement, just trying to understand this system better. Thank you! Keith

Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA

lynncrni
 First, anyone using a PICC

 First, anyone using a PICC and trimming it to be a midline is setting up a dangerous situation and this practice should be stopped. At AVA, Russ Nassof, an attorney specializing in healthcare risk management, answered this question from a group of people after our presentation. The answser from both of us was NEVER cut any device to alter it so that it has become another type of device. 

I think the question about using tPA for declotting a midline catheter is coming from the package insertion and Genentech literature stating to only use it on a CVAD. These statements are based on the work done in the clinical trials of using a low dose of clearing CVADS. No midlines were used in that study, therefore the manufacturer would not be allowed by FDA rules to include midlines in their list of indications for use. I do not know of any other data on tPA clearance of a midline catheter. The risk may be different but we simply can not say due to this lack of data. We know that blood flow is slower at a midline tip location than the CVAD location along with a smaller vein diameter. This makes it more difficult to determine exactly where is the problem - inside the catheter lumen or inside the vein around the catheter. There is the distinction possiblity of phlebitis from a chemical cause at the catheter tip, whereas a CVAD does not have this issue due to vein diamter and blood flow. For me, it would come down to a risk vs benefit decision for each patient, but you would need a hospital p&p to back you up on using tPA for midline clearance. Without a labeled indication, this p&p might be difficult to get approved. So we are back to the beginning. Research is definitely needed. Lynn

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

Toni T.
Cathflo

Does anyone else use Cathflo in their hemodialysis catheters? 

lynncrni
 Yes and there are studies of

 Yes and there are studies of locking HD caths with tPA for periods between dialysis. Lynn

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

Chris Cavanaugh
2mg in 2mL

 

Most hospitals I have worked with across the country have a policy stating 2mg in 2mL and use a stopcock to admiinister.  If the catheter is blocked completely, it will be impossible to get the entire 2 mL in.  You can ask your Genentech rep for a sample policy, or check on this site under resources.   

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Linda C. Smith
SC lidocaine for PICC insertion

We use 1ml of lidocaine SQ for PICC insertions.  We do check the allergy list carefully and ask the patient about allergies as well as we have encountered a handful of patients who report an anaphalactic reaction to lidocaine in the past.

Linda C. Smith, RN

Ann Marie
PICC/Midlines and Cathflo

Cathflo is for central lines and is not indicated for Midlines.

The 110% of the catheter volume is for patients under 30 kg  (mainly peds), per package insert

As indicated by others Central lines are often trimmed so an accurate device volume is difficult to obtain. 

You can go the website of the manufacture of the central line that you use to obtain the fill volume of the device prior to any trimming

 

Ann Marie

 

Disclaimer I am a CNT for Genentech

Toni T.
Off label use of Cathflo

I was told by the Genentech rep that Cathflo is not labeled for HD catheters and it would be off label use.  Do the studies support the off label use?  Is declotting the pigtail still off label use?  I am a little confused as to why a dialysis catheter is not considered a central line to begin with.  Any thoughts?

lynncrni
 Off label use is a decision

 Off label use is a decision made by the indiviaul operator based on patient needs. Lynn

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

Kristine Selck
We are currently developing a

We are currently developing a midline policy at my institution. What is the reason for not using tPA in midlines? We would like to have the option of using it in cases where replacing the line would be extremely difficult.
Thank you,
Kristi Selck

We are developing a midline policy.  Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?

Thank you,

Kristi

Log in or register to post comments