Currently we have do not allow patient's with open-ended or non-valved VAD's to be discharged for home therapy or to LTC.
But we are seeing a large number of hemolyzed specimens following blood draws from a valved PICC and are considering a non-valved PICC.
Just wondering about the safety of discharging a patient with a non-valved or open-ended PICC. Can anyone share their experiences or policies?
thanks Peggy
Not all hospials use CVADs that have an integral valve and they send patients home all the time. The use of a CVAD with an integral valve is not required for home care. In fact, there are several case reports where the Groshong valve has allowed air embolism in a home care patient because of thrombus accumulation holding the valve open. There are other reports of explanted valved catheters with intraluminal clotted blood, again due to an open valve from thrombus/fibrin. Even with a valved catheter, all precautions for prevention of air embolism are required.
RE hemolysed samples, how do you know that the valve in the CVAD is causing this. More than likely it is the technique being used to withdraw the sample.
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
Lynn, thanks for the response. The PICC vendor shared reluctantly, that they recently switched to a new valve that was "stiffer" at approximately the same time our hemolysis rates tripled. We also did some mini studies using experienced, trained nurses and different drawing techniques using to see if the process was an issue. No matter which process we used, vacutainer versus syringe draw, there was no real affect on the hemolysis rate. The only thing we can conclude is that is the catheter itself.
One of the trial arms included using a smaller syringe (5ml) to withdraw the blood with a slight improvement in the hemolysis rate. What are you thoughts on that?
Thanks, Peggy
Peggy Hampton, RN
Clinical Education Specialist
Yuma Regional Medical Center
I have been doing Home Infusion for 19 years now. We get patients from a variety of hospitals/states. I can't remember the last time we had a valved catheter, and have never had to be concerned about this issue or had any problems presented. Good luck!
what valved catheter do you use? We have seen an increase in hemolysis with the bioflo picc. We have let our rep know of the concerns and they are adjusting the tension on the valve to reduce this problem. Just curious. Thanks!
Molly
Molly M. Black, RN, BSN, CRNI, VA-BC
Specialty Practice Nurse
Vascular Access Team/Clinical Education and Practice
Indiana University Health Bloomington
812.353.9021 l 812.353.5062 (fax)
[email protected]
Molly Judge, RN, BSN, CRNI, VA-BC
Specialty Practice RN
IU Health Bloomington Hospital
Do you agree that all PICC that do not have a continuous infusion are indeed valved PICCs?
The valve may not be intergral.
The facility may be using a PICC with a valve which is applied.
It could be a positive, neutral, or neg displacement valve.
The PICC would definitely have a valve on it, right?
There would be no difference in care except the cap needs to be changed with the dressing change, correct?
Celia Brown
I don't think I agree with you. Any catheter with any type of valve built into the internal or external catheter is quite different from a needleless connector added to the catheter. When I talk and write about a valved catheter, I am referring only to that family of catheters with a valve built intlo the catheter itself. A needleless connector is a separate device. This is the approach taken by the INS textbook and the INS SOP. 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 have been doing home care and home infusion for a number of years at various home care/home infusion companies. Most of the PICCs and other CVAD's we care for are not vavled. We do not have any more problems with one type vs another. We get many types and brands from a multitude of facilities.
Ann Marie
Ann Marie Parry, RN, CRNI, VA-BC
[email protected]