Where is the catheter tip located? Is this location the original placement or has the tip migrated to another location? The movement may have caused additional endothelial disruption so the area of thrombosis may be longer. Do you have a dye injection through the catheter to see if there is any amount of fibrin sheath? The procedure of instilling tPA into the catheter lumen is such as small volume and small dose and it will only affect anything that is on the internal lumen and directly at the catheter tip. Suboptimal tip locations outside the SVC are most often associated with vein thrombosis, so the instillation procedure may not have any impact on what is in the vein lumen. So the procedure may not be successful, but I am not aware of any negative outcomes from instillation when the tip is in these aberrant locations. Lynn
I agree with Lynn, however, have this question. Since Genentech, the makers of CathFlo adhere to the guidelines of INS and AVA, if cathflo were to be instilled in a picc line where the tip does not reside in the distal 3rd of the SVC, wouldn't this be considered off-label use of the product? If any adverse events happened, the company would not back up the use of their product since all their literature and studies support use of CathFlo in a Central Line or PICC Line which by definition must have the tip residing in the distal SVC.
Where is the catheter tip located? Is this location the original placement or has the tip migrated to another location? The movement may have caused additional endothelial disruption so the area of thrombosis may be longer. Do you have a dye injection through the catheter to see if there is any amount of fibrin sheath? The procedure of instilling tPA into the catheter lumen is such as small volume and small dose and it will only affect anything that is on the internal lumen and directly at the catheter tip. Suboptimal tip locations outside the SVC are most often associated with vein thrombosis, so the instillation procedure may not have any impact on what is in the vein lumen. So the procedure may not be successful, but I am not aware of any negative outcomes from instillation when the tip is in these aberrant locations. 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
I agree with Lynn, however, have this question. Since Genentech, the makers of CathFlo adhere to the guidelines of INS and AVA, if cathflo were to be instilled in a picc line where the tip does not reside in the distal 3rd of the SVC, wouldn't this be considered off-label use of the product? If any adverse events happened, the company would not back up the use of their product since all their literature and studies support use of CathFlo in a Central Line or PICC Line which by definition must have the tip residing in the distal SVC.
Thanks.