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SANDRA OCONNELL
POWER PICCS

DOES ANYONE HAVE EXPERIENCE WITH THESE? WANT TO KNOW IF THEY HAVE TO BE FLUSHED WITH HEPARIN , AS PER MANUFACTURERS SUGGESTION. AS MY HOSPITAL IS MOVING AWAY FROM HEPARIN FLUSHES .

THANKS

Wendy Erickson RN
Yes, there are many of us
Yes, there are many of us using power PICCs and there is nothing about a power PICC that dictates what it should be flushed with - heparin or saline are both acceptable based on your policies/procedures.

Wendy Erickson RN
Eau Claire WI

lynncrni
The only difference with

The only difference with most PICC rated to accept power injection is they will always be polyurethane because it is stronger and they may be larger sizes. The need for heparin depends totally upon the presence of a valve built into the catheter or an add-on needleless connector that has instructions for saline-only flushing. No integral valve and a needleless connector without saline only instructions means heparin should be used. This is the same for any catheter.

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Deb Gnegy
Are they required

Are they required togther? 

Will a postive pressure saline-only connector allow for saline only flushing or is a valved catheter also needed.

Deb

 

Deb

estevens102206
Deb, a positive

Deb, a positive pressure connector allows for saline only flushing if the correct protocol is followed. You do NOT need a valved catheter for saline only. 

Eric

Eric

daylily
If you visit the BARD

If you visit the BARD website it states the power PICC can be used with saline only every 8 hours.

In the past 6 weeks my hospital switched to saline only.  We instituted a policy where the catheters had to be flushed every 8 hours unless in continuous use.  We saw a drastic rise in occlusions requiring alteplase.  After speaking with my rep. he felt it was a care and maintenance issue.

I went around re-educating and the rates have dropped by not to where they should be.  For this reason I am looking at the SOLO.  We use a positive pressure cap.

tjack
Have replaced Solo's due to

Have replaced Solo's due to occlusion, difficult to declot due to the fact that it would not allow adequate aspiration, only about 0.1cc, spent a couple hours trying to declot and eventually put another in the other arm. May be due to the valve and the catheter being clotted as well? I believe the SOLO recommends a positive pressure cap, which seems to defeat the purpose of the built in valve. As many here have stated with other valves/end caps, after aspiration for blood sampling it is difficult to clear the cap of residual blood, not sure if this is true of the SOLO and the built in valve. After blood sampling we change the cap all together to be 100% sure the valve is clean.

Some times I think all of this new technology makes things more difficult. Rarely have occlusion problems with the simple non-valved open ended catheters and a positive pressure cap.

Timothy L Creamer
Yes the SOLO recommends a

Yes the SOLO recommends a positive displacement valve connector. This does not defeat the purpose of SOLO's integrated valve though, it ensures the valves optimal function which is to maintain the column of saline in the lumen once the infusion valve closes. This prevents any reflux because there is no dead space on that side of the valve in the hub. When used with a "neutral" displacement connector (which is still negative) the action of disconnecting the syringe will open the aspiration valves to some degree and allow blood reflux in the distal lumen(s) resulting in occlusions. The likely purpose defeating action a facility can do and it is recommended for SOLO catheters being used with negative pressure connectors is to add an extension set with a clamp to the hub, by clamping before disconnecting the aspiration valves should not be affected. But let's face it, many facilities have probably switched to the SOLO's because it is too common to find the majority of bedside nurses not performing the proper flush/clamping sequence, if they even utilize the clamp at all. The Max Plus Clear connector is a positive displacement valved connector, easy to disinfect prior to use due to the flush septum port, clear so the user can visually verify blood clearance, drug precipatates can also be seen. Common inservicing with this product includes to change it if all visible blood is not cleared with 20cc saline flush. At least it is visible to assess, think about all the flushes performed without a clear housing of only 5-10cc saline and what remained to produce bacterial offspring? What about all the bedside nurses that think just opening or resuming the IVF's is an adequate flush? The SOLO is a great product, but if a facilty is not committed to a small but added expense of a connector like the Max Plus Clear then the outcomes are going to be suboptimal. And who is the ultimate loser? The patient is! A single dose of Cathflo, the labor cost of just reassing the occlusion much less performing the declot procedure, or replacing the entire PICC far exceeds the financial pinch felt for upgrading to the proper connector.

Timothy L. Creamer, RN

Essential Vascular Access, P.A.

Clinical Educator, Bard Access Systems

PICC Team Leader, Regional Medical Center Bayonet Point

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

estevens102206
Nice marketing promotion

Nice marketing promotion for Bard again Timothy.  Seems like there sure is a lot of defending of these so called great SOLO by the nurses paid by the company. 

Eric

Eric

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

This is not about a catheter brand at all but Y-sites

There was a very nice poster at LITE this year by Patty Luptak on occlusions that I learned alot about

If you have an intermittant infusion (one not hooked up) and you have a positive pressure cap on the end of a PICC a saline flush if the cap is approved for saline works fine

If you have a continuous infusion on the other hand that is hooked up with a tubing with y-sites not so good according to the poster for any cap.  Let me explain what Patty found out.  The tubings on the Y sites have negative pressure caps which negate the positive pressure cap at the bottom attached to the catheter.  You now have a negative system not a positive system or neutral system.  Most caps on the Y site are negative systems.  So when giving an IV push or disconnecting a bag you have reflux in the catheter unless you do a positive pressure flush.  The bag of fluid at the top when turned on may not rinse the line.  Flow and distance are crucial.  One needs to flush after IV push and after med disconnect if it is a continuous line with negative tubing sites.  I hope Patty shows that poster at AVA.  Patty Luptak where are you to explain this?

Kathy

Kathy Kokotis

Bard Access Systems

lynncrni
I don't quite understand the

I don't quite understand the physics of this from Kathy's message and would love to see Patty's poster. If I am reading Kathy's message correctly, this could be another reason for not having a needleless connector in the line for continuous infusion (I am talking about infusion over many hours or days, etc). I have never practiced with these inline for continuous infusion and have always thought that at best they were not needed and at worst could add to infusion problems. But I am very interested in this poster.  

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Deb Gnegy
Kathy, I'm not getting the

Kathy,

I'm not getting the mechanics either.

How does an infusion pump fit into this senario (primary infusion set to restart after the secondary infusion is complete)?  Is the pump providing any positive pressure?

Thanks

Deb

Deb

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

We should invite Patty Luptak to present her findings at a conference.  It is not device specific.  I would like to hear it

kathy

Kathy Kokotis

Bard Access Systems

We switched to POWERPICCs

We switched to POWERPICCs about 2-3 yrs ago (can't remember exactly when) and use the CLC2000 postivite pressure valves. Also stopped using Heparin withOUT an increase in clotting as long as CLC2000 was used as directed. 

 Raquel M. Hoag, CRNI

 

Raquel M. Hoag, BSN, RN, PHN, VA-BC

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