Subject: PICC Declots
We are updating our clinical policies for PICC line catheter declots. In the past we have followed the manufacturer’s directions for use. There has and still is confusing for staff nurses that don’t perform this procedure routinely, particularly on the totally occluded catheters that can take a while to declot. We are trying to come up with more “user friendly” instructions for our staff nurses that still follow the guidelines. Anyone else had this issue? Thanks for you comments!
My preference would be to leave this procedure completely in the hands of infusion nurses. If your team is only doing VAD insertions and there is no time for your staff to assume these procedures, then perhaps it is time to use this to justify more staff and to expand your team. I think your difficulties speak to the fact that this procedure requires special knowledge and skills beyond that of the primary care nurse who does not have the time and sometimes lacks the motivation to master this procedure. I would also want to look at the number of these procedures and analyzse why the incidence rates may be high. What is or is not happening to require this procedure? In my opinion, it should be rarely required. But then again, maybe that is also part of the problem - all staff nurses do not have the opportunity to perform the procedure often enough to master the skills. This is yet another reason to leave it in the hands of infusion specialists. 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
Thanks for the comment Lynn and we couldn't have said it better! Our hospital went heparin-free September 1, 2012 and shortly thereafter saw an enormous amount of clotted PICCs - too many! Unfortunately we don't have the staff to check all the troubleshooting that is required when a complaint of a clotted PICC comes in as we are generally in the reactive mode due to the large number of PICCs we place. We try to get to the ones we can, but this is generally hit or miss - we feel strongly that there is a liklehood that a number of these are not truly clotted. Hiring more staff is not an option at this time we have been told. We have tried every approach known to justify more staff, even having Kathy Kokotis formulate a business plan for our facility. Our hospital recently (March 25th) switched over to the Bard Solo PICC to see if these numbers come down-we are starting to hear about clotted PICCs, despite Bard's very extensive hospital-wide teaching. I know that many facilities have been "heparin-free" for many years. Those that are more successful likely have more staff available to allow for troubleshooting, declots, and more focused teaching when there is a need identified. Cindy
Cindy Hunchusky, BSN, RN, CRNI
Our hospital policy only allows staff to infuse cathflo into a line that still flushes but has no blood return. As we are only available approx 12 hours a day we felt it in the patients best interest to get these lines flowing before they became totally clotted. Once totally clotted only the vascular access team and a couple of well trained CCRNs are allowed to administer cathflo to totally clotted PICCs. The drug reps come regularly to reinforce training for cathflo instillation on sluggish only PICCs/CVCs. Our staff has learned before using cathflo or calling us during the day, to change the caps and try flushing/check blood return again as we find the cap is the issue many times.
Unfortunately we have to practice in the real world of budget cuts and try to pick what we really need to have the most control over for patient safety. We have not had any incidents with using this protocol.
We went heparin free several years ago. Our incident of HIT has gone down a necessary issue in patient safety to consider and weigh in the balance of developing good flushing protocols and needing a little more cathflo. We haven't had huge issues.
Mary Penn RN Vascular Access Team