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Nancy Safranek
Solo PICCs
I promise this is my last question. Last summer we switched completely to Bard Solo Power PICC and have had issue with both our ability to get accurate CVPs and the seeming plethora of clotted picc's. I personally don't think the clotting problem is quit as awful as some of my peers but have others had these issues and how were they handled? (I did read the old post on CVPs but wondered if there was new information) Thanks again, Nancy
lynncrni
The presence of a valve

The presence of a valve inside any catheter would prohibit all types of hemodynamic monitoring being done through that catheter. This applies to all catheters with valves, not just the SoloPICC. These valves require force from infusion (gravity head pressure or pump pressure), injection (manual force on the syringe), or aspiration to open. This force being applied would interfere with the pressure monitoring being done. Catheters with valves do not open without this force applied. So I don't think you will ever be able to do any type of pressure monitoring through a catheter with a built in valve. 

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

www.hadawayassociates.com

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Eve Agarvan
The SoloPICC has a lumen

The SoloPICC has a lumen without the valve on the triple lumens.

 

Eve - KY

PJ2008
Eve, what you have stated
Eve, what you have stated above is incorrect.  The Bard PowerPICC SOLO has valves on EVERY lumen, single, dual, and triple...there are no lumen without valves.
Timothy L Creamer
You are correct, all lumens

You are correct, all lumens of SOLO PICC's are valved. This is what is shown on the BAS website and my own personal observation.

As vascular access nurses we have a duty to be knowledgeable regarding the products utilized. Every PICC manufacturer has a website listing their products and IFU, patient guides, nursing guides, .... What we do can become routine, but make no mistake, we perform invasive procedures that potentially can have devastating complications during or post insertion. 

Timothy L. Creamer, RN

PICC Team Leader, Regional Medical Center Bayonet Point

Clinical Educator, Bard Access Systems 

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Timothy L Creamer
Just a correction, I posted

Just a correction, I posted earlier the Groshong catheter has a 'two way valve'. Bard Access Systems IFU and Nursing Guides describe a 3 way or position valve: aspiration (negative pressure), infusion (positive pressure), and closed (neutral pressure).

Apologies if this caused any confusion.

Timothy L. Creamer, RN

PICC Team Leader, Regional Medical Center Bayonet Point

Clinical Educator, Bard Access Systems

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Robbin George
As far as clotting issues
As far as clotting issues with the SOLO you need to look at (1) End cap being used (Negative is contraindicated) and the frequency of cap replacement (2) Flushng technique--NS volume (routine 10mL flush before and after administration and 20 mL following Blood draw)--I stress too that Flushing MUST follow immediately after manipulation of any CVC and that Pump alarms require ASAP attention as any stagnation of flow will exacerbate the possibility of catheter occlusion issues    

Robbin George RN VA-BC

fizerjk
If I am not mistaken the
If I am not mistaken the Solo Power PICC is capable of providing accurate measurements of CVP. ( I have witnessed this. Excellent wave form and CVP measurements consistent with those taken using a traditional CVC line.)

Jeffery Fizer RN, BSN

Alma Kooistra
I looked for and didn't see

I looked for and didn't see where it says that the SOLO PICC is supposed to be flushed with 20 ml saline post blood draw.  I think it's a great idea and I'll put it into policy if someone will let me know where it is.

Also, we've been using the SOLO PICCs for around 6 weeks now and I have heard multiple complaints about how difficult it is to draw blood back though these devices.  I drew from one of them for the first time last week and found out what the nurses were complaining about.......it was very difficult and time consuming.

I'm wondering if there are any ideas floating around out there which help for this. 

Also......when we were using open ended PICCs I taught that using a smaller syringe should facilitate more rapid flow when drawing blood.  I'm wondering if that same principle applies for the valved SOLOs or if I should be recommending use of a 10 ml syringe for blood draws now, since they generate greater negative pressues.  I'm concerned about lysing the cells.....

Thanks!

Alma Kooistra RN CRNI

Timothy L Creamer
The IFU (Instructions For

The IFU (Instructions For Use) and the Nursing Guide on Bard Access Systems website reference a 20ml normal saline flush prior to blood sampling from a line with TPN infusing, otherwise 10ml normal saline flush is listed. It is common to teach a 20ml normal saline flush post blood sampling, I was taught this years ago while working with homecare patients.

In response to blood draws from SOLO PICC's, difficulty has been a frequent 'complaint' from nurses. Mostly from nurses used to nonvalved open ended catheters. In my experience when drawing blood specimens from a Groshong catheter (tunnelled or PICC) a small saline flush was required in order to obtain a blood return. Quick review, the Groshong has a two way valve at the catheter tip, the SOLO has 3 one way valves (1 for infusing, 2 for aspiration) in the hub. Blood withdrawl from a SOLO PICC outcomes are improved if the valve is 'exercised' first by flushing with 10cc saline then aspirating. Slow steady aspiration of blood will produce an optimal specimen. Use a 10cc syringe but aspirate slowly, pause then resume slow aspiration if needed. Some clinicians report positive outcomes by initially aspirating to the 2cc increment, maintaining negative pressure momentarily for the aspiration valves to open.

SOLO was approved for CVP monitoring. The valve dampens the waveform and values by 20%. Comparitive waveforms and values need to be correlated. I am awaiting permission to post a short Power Point regarding CVP monitoring with SOLO. 

Hope this helps.

Timothy L. Creamer, RN

PICC Team Leader, Regional Medical Center Bayonet Point

Clinical Educator, Bard Access Systems

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Robbin George
We have inserted and
We have inserted and maintained more then 1000 SOLO PICCs and have discovered that drawing blood requires a certain amount of patience and finesse--Like any valved catheter (Groshong and PasV included) the plunger of a 10mL syringe WILL collapse the catheter if too much reverse pressure is used to withdraw--We recommend a very SLOW PULL/PAUSE motion--You can also use a Smaller syringe (3mL) to start the flow and then collect your sample in a 10mL syringe or even by Vacutainer--We have always flushed with 20mL NS following Blood draw from all CVCs and I do believe it is stated as such in the SOLO product manual   

Robbin George RN VA-BC

Heather Nichols
Nancy,    The CVP readings

Nancy,

   The CVP readings on a regular open ended PICC are different from a CVC by a point or two, and you cannot do CVP readings on a PASV or Groshong catheter, so what does that tell you about the valve on the SOLO PICC? 

   The first thing you need to do is start measuring your outcomes to determine if the SOLO you are using is worth the money you are paying, and the extra care and maintenence it requires.  There are several other catheters on the market that are less expensive, require less care and maintenence, and have better outcomes for your patients.  If you have a valved catheter, you should not need special end caps that cost more to prevent occlusions.  I have used the PASV successfully with a regular interlink cap for years with a very low occlusion rate.  We use a power injectible PICC for those that require it (which should be assessed, not taken for granted) with a neutral end cap.  It has more occlusion problems, just as SOLO does, but it is a whole lot less expensive.  Therefore, addition of extras, like the cap, and more care and maintenence issues are more off set than having an expensive catheter to add all of that to.

  You can not know how a catheter is performing in your facility unless you are measuring your out comes.  It is very important these days.  We tried the SOLO, and had horrible out comes.  We are awaiting the release of the new PASV power injectable catheter around the first quarter of next year, or maybe some improvement to the SOLO.  Which ever comes first.  Good luck, and email me privately if you would like to speak more on how to track you statistics.

Heather

[email protected] 

PJ2008
Rep here.....Your reasoning

Rep here.....Your reasoning for the SOLO PICC and CVP is inaccurate.  The SOLO is FDA approved for CVP monitoring and will give you accurate readings.  The PASV does not have an FDA indication and you cannot monitor through the groshong because it is a closed ended catheter. 

On the cap issue, Bard recommends positive or neutral, this does not neccessarily mean a facility has to pay more money to use specific caps on the SOLO as many facilities already use these types of caps.  Don't you have to pay for your interlink because there are no caps in the PASV kit?

 

 

Heather Nichols
 Vascular Access Specialist

 Vascular Access Specialist here-  I am going strictly by our experience with Solo.  And by the way, the PASV and the Solo are valved catheters which makes them closed catheters also.  FDA approval does not mean it works.  Wish it did, but we trialed the Solo fair and square and did extremely close documentation on it.  I also spoke with several other facilities (as well as Paul Blackburn and the engineer of the Solo) who had good as well as disaterous out comes to make sure we were not alone in the statistics we came up with.  We were not.  Many more facilities had lots of problems.

  As far as the cap goes, neutral or positive, they cost more than the interlink (or most of the neg caps) by far.  I will not quote price in public.  A valved catheter (that works) should not need anything more than the valve.  Yes, we pay for the Interlink caps, but it is far less than the others (neutral and positive) and the cost of our current catheter, is far less than the Solo.  It is a win win situation, with better outcome data.  

  I am not out to sell a particular catheter.  I am out to do what is best for my patient.  I am a nurse first, and a consultant second.  I trial any new products without manufacturer bias, if I believe it will benefit my patient.  Reps should do the same.

Heather

Saharris
Heather, I am wondering

Heather,

I am wondering if you are suggesting by your comment "a valved catheter (that works) should not need anything more than a valve", that end caps are not necessary on a valved catheter? For obvious infection control reasons all PICC's should have an endcap.

I personally do not like the interlink due to the massive reflux that occurs with syringe disconnection. I would not say the interlink does not work, only that I don't like how it works in my practice. It is obvious from this forum that the Solo works very well for thousands of patients and clinicians. If it works for many different clinicians I think it is only fair to say it has the ability to work everywhere, but some change in practice may have to occur in order to provide patient benefits. The Solo(or any other medical devices) are tools that we use as clinicians to help return our patients to their maximum function. It is important that we realize these tools are the constants in the therapies that we give our patients, it is our practice as clinicians that changes. "Fair and Square" trials are therefore only fair and square if all the tools have been put in place to achieve the best outcomes.

Stephen Harris RN, CRNI

Carolina Vascular Wellness

Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness

Francine Parent
Hi Heather;  I am the

Hi Heather;

 I am the Clinical Consultant for Materials at Sharp HealthCare in San Diego.  We are the largest IDN in San Diego. Sharp HealthCare has recently done a system wide trial with the Solo PICC and the Vascular Access team had decided to convert to it.  Recently, they have had an extremely high incidence of clotting issues and are considering discontinuing it's use.  They have asked me to compile some data from other hospitals in the Country, to see if anyone else is having trouble with this product.  It looks like you have done an excellent job of gathering this data and I was wondering if you would mind sharing it with us. If you would like your data to remain confidential please feel free to contact me directly at [email protected] or by phone at 858-637-6440.

Thank you so much for your help with this, since we all would like to do what is best for our patients.

Best Regards

Francine Parent RN

Sr. Clinical Consultant

Supply Chain Services

Sharp HealthCare

4000 Ruffin Road Suite A

San Diego, CA  92123

Michele Anderson
Michele Anderson,RN,BSN Our

Michele Anderson,RN,BSN

Our goal was to become an almost heparin-free institution with the switch to Solo picc which we did for several months. The issues we consistently ran into were: significant increase in occluded catheters requiring use of cathflo & inability to withdraw blood. We were very hopeful initially and trialed the product for almost 3 months but eventually had to revert back to just power piccs, not Solo.

 

 

Michele Anderson,RN,BSN

Heather Nichols
Stephen,    I was not

Stephen,

   I was not suggesting, nor did I ever say , that you should use no cap at all.  Of course you should cap the end.  What I said, was that a valved catheter (that works as it should) should not reflux with removal of the syringe.  It should not need a neutral or positive pressure end cap.  It would be an added plus of course, but if you have the choice of two end caps, one is lets say, $4.00, and one is, lets say, .69$, and both work equally as well as the other on the current catheter you are using, which one would you use? 

   My point here was never end caps to begin with.  It was all about proper data collection to support the claim that a catheter is working well for your facility or vise versa.  How can you know if you do not do proper data collection to find out?   A guess or what you hear, is not going to work.  In the original posting, it seems as though the nurse is not sure whether they have an occlusion problem or not.  She definitely does not know how much it is.  In order to fix it, you must have documented evidence that a problem does or does not exhist in order to know how to procede.  We documented the results of our Solo trial well, so we knew without a doubt how we needed to procede.  We had all of our "tools" in place, believe me.

The end of my last post clearly stated that I am a patient advocate first and for most.  I believe in using only the best "tools" for my patients, but I am also cost conscious on their behalf. I would never compromise care for cost, but unfortunately, it is a must to at least be aware of cost these days.  I am sorry I did not make myself clear.  I hope I have now.

Heather 

Timothy L Creamer
Caution: Always remove
Caution: Always remove needles or syringes slowly while injecting

the last 0.5 ml of saline.

Caution: Use aseptic techniques whenever the catheter lumen is

opened or connected to other devices.

Caution: The PowerPICC SOLO* catheter is designed for use with

needleless injection caps or “direct-to-hub” connection technique.

Apply a sterile end cap on the catheter hub to prevent

contamination when not in use. Use of a needle longer than 1.6cm may cause

damage to the valve.

The above references are excerpts found in the Nursing Guide for SOLO PowerPICC (also in the IFU).

Yes, I have taught SOLO users the importance of positive displacement end caps mainly because so very few nurses practice a true positive pressure flush. We used Interlink split septum connectors for years, positive pressure flushing and correct clamping sequence were essential to maintaining patent lines. Many PIV restarts were performed due to the absence of positive pressure flushing and PICC's declotted or replaced from a result of occlusions.

However, Bard Access clearly state in the IFU and Nursing Guide to disconnect syringe while slowly injecting the last 0.5ml of saline. In my experience, using and observing nursing technique, with the Interlink system on PICC's and CVC's 0.5ml of saline was inadequate to prevent reflux.

Heather, initially I was curious regarding your stated negative outcomes while trialing SOLO PowerPICC but after studying your comments the tone indicates long term dissatisfaction.  I wish you continued success and positive patient outcomes with your current brand of PICC's.

Lastly, I urge everyone to identify themselves. If your a rep then state who with, if your a consultant then state who for. Besides being a requirement for this list server, posting name, credentials, and affiliations is being professional. Noncompliance, especially when expressing strong reviews or feelings toward a specific topic or product, creates doubt, bias, and skepticism.

Primum non nocere.

Timothy L. Creamer, RN

PICC Team Leader, Regional Medical Center Bayonet Point

Clinical Educator, Bard Access Systems

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Heather Nichols
Timothy,    I was

Timothy,

   I was dissatisfied with Solo.  I love my Bard rep, I have two Site-Rite 6's, and we use the Bard power triple.  Does that sound like I have something against Bard?  They have good products also.  I also helped to make sure we were placing Bard Power ports in our vascular and surgery suites. 

   I am very sorry my main point is not coming accross here, but I am at the point where I have decided to give up. It's just not gonna happen.  I hope the person who posted the original posting got past products and heard what I had to say about proper documentation and outcomes. It will help you to prove a point even if some people just don't want to listen.

    Also, I am not sure if you meant me or the rep I was returning answer to, but my title is clearly stated above, and I am contracted with no one but the University of Louisville Trauma Center. I am a vascular access specialist full time.  I do occasional work for J & J, Corpak, Arrow, and Navilyst, but I am contracted with none of them.  Unfortunately, my email tone seems to never be good no matter how hard I try.  That is why I do not post much anymore.  Only on things I feel passionate about.  This topic is one of them. 

Heather 

Timothy L Creamer
Heather, Many apologies for

Heather,

Many apologies for a delinquent response as I was out of town a couple days without my laptop. Thank you so much for your comments. Your main point of patient outcomes, documenting the process, and evaluating objective non bias data to provide the best solutions/decisions for your patients was clear from your initial posting. I could not agree more. Primum non nocere.

Your passion is clear, your priorities obviously patient centered, and your product evaluation process solid. When I mentioned tone please understand it was not meant negatively, in retrospect it was not the most appropriate term.  I encourage you to continue posting comments, your input is valuable.

I believe you posted an email address earlier, I am interested in your SOLO evaluation and outcomes. Will be in contact. Thanks again.

Timothy L. Creamer, RN

PICC Team Leader, Regional Medical Center Bayonet Point

Clinical Educator, Bard Access Systems

P.S. I was addressing any representative of any company/vendor in any capacity, your listed credentials are greatly appreciated.

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Rhonda Wojtas
I do use the Bard Power PICC

I do use the Bard Power PICC Solo and it is the only PICC line we currently use. We found that we were having problems as well but as I investigated further. Our flushes were on our electronic system as a PRN and not a scheduled flush. I could not be sure the lines were being flush as it was a prn and rarely documented. We have since made a every 8 hour routine flushing of unused ports, we seem to be having less occulsions.

I know when we started doing PICC's, we started seeing more occlusions. However the floors went from seeing 20-30 per month to seeing 60-80 per month. More volumn means more need to use cathflo for occlusion. In perspective 1 in 4 lines will have an occlusion.We are within the 1 in 4 ratio, just higher numbers because of higher volumn.

Hope that helps.

Rhonda Wojtas, RN PICC Team

Lowell MA

Rhonda Wojtas, RN VA-BC

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