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Louise Oak
Recent increase in defects with Bard DL Groshong PICC
We have been using the Bard DL groshong since 2001. Recently staff in our Medical Day Care  and Oncology units have brought this problem to our attention.
When flushing the white lumenof a DL Groshong, blood will reflux into the red lumen, and vice versa.
Suspecting communication between the lumens we notified our rep, pulled the line and sent it for investigation.
They informed us that indeed there was a split in the septum between the lumens, but they did not know whyor how this had occurred.
This has now happened 5 times in the past year.  We seem to be the only ones with this complaint.
Has anyone else experienced this phenomenon? Are you able to ask the services that care these PICC lines if they have seen this?
Our insertion practice has not changed. There are only 2 of us inserting PICC lines. We are confident with the care and maintenance of the nurses in the areas that are caring for these lines. We are baffled that we are the only ones experiencing this problem.
Timothy Royer B...
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Daphne Broadhurst
Hi Louise, We had 1 case

Hi Louise,

We had 1 case that I know of last month with similar situation, same catheter type. However, this patient also had a line-o-gram -confirmed fibrin sheath & hence persistent withdrawal occlusion (Cathflo instillations effective for only a short time). We had postulated that perhaps the sheath could somehow have caused the blood reflux. We pulled the line as a Cathflo infusion was unsuccessful in resolving the intermittent w.occlusions.

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

Terry Hall
I had this problem with a
I had this problem with a long term home infusion patient who also had a dual lumen Groshong PICC. I too recognized that there was a communication between the two lumens. I had the patient return to the hospital where the line hd been placed. The hospital replaced the PICC with the same product.
I have not seen the problem reoccur with this patient. Perhaps a bad lot???? Bard should be able to track the catheters using the lot number which should be documented with each PICC insertion.
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T. Nauman RN, CRNI  IV

T. Nauman RN, CRNI  IV Educator SHMC Eugene, OR

We've had this happen once with a Bard dual lumen Groshong catheter and three times with dual lumen power piccs.  This was several months ago and it hasn't happened since then.

T. Nauman RN, CRNI

Daphne Broadhurst
Diane, we don't yet have an

Diane, we don't yet have an Alteplase infusion policy. If a line-o-gram-confirmed fibrin sheath is diagnosed, we will request the doc to order Cathflo 2 mg in 50 mL NS. Below are a couple of references (unfortunately there seems to be no published lit on alteplase infusions in non-dialysis cvads).

Daphne

Dowling K. et al. The use of tissue plasminogen activator infusion to re-establish function of tunneled hemodialysis catheters. Nephrol Nurs J. 2004; 31(2): 199-200 (Alteplase 10 mg over 2 hours as a 2.5 mg/hr/catheter infusion: 100% success rate in 25 occluded catheters)

Savader, SJ et al. Treatment of hemodialysis catheter-associeated fibrin sheaths by rt-PA infusion: critical analysis of 124 procedures. JVIR; 12(6):711-715 (sorry I don't have the year of publication)

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

Daphne Broadhurst
Sorry, meant to add the

Sorry, meant to add the alteplase infusion is over 3 hours.

 

Daphne Broadhurst
Desjardins Pharmacy
Ottawa, Canada

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