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Elizabeth.Raucci
TPA alteplase conts. infusion

Our policy in treating CVC occlusion or withdrawal occlusion is to use 2mg TPA. May repeat a second dose if needed. This is after an assessment is done to determine the cause. In our cancer and long term VAD patients we have treated with a continuous infusion of TPA 4 mg in 50ml normal saline to infuse over 4 hours.THis is to treat the fibrin sheaths/ tails. We have had 100% success with this. It isn't done to often and usually out a the outpt infusion center.

Anyone doing a continuous infusion?

stemc
From my recent conversation

From my recent conversation with our Vascular Access Rep, the Microclave is contraindicated with the SOLO's.  The probem is your endcap, call your power picc rep and find out which one is indicated for use with it.  We are in the process of finding out the same information.

Gwen Irwin
We have been saline only for

We have been saline only for more than 3 years.  We added the PowerPICCs a few months ago and have not had an increase in the number of occlusions since that change.  We have PowerPorts also and have not seen an increase.

Some of this is might be technique driven and related to the type of cap.  What education occurred for flushing?

Gwen Irwin

Austin, Texas

palyons
I was concerned when I saw

I was concerned when I saw the post regarding the MicroClave cap and Solo's. I spoke with the Bard representative and the MicroClave is no problem with the Solo's as this is a neutral displacement valve. Bard recommends either  positive or neutral displacement caps (per manufacturers product information). They do not recommend negative displacement devices. This was confirmed by ICU medical which makes the MicroClave. I believe the Clave is a negative displacement device and this is probably what the Vascular Access Rep was speaking about.

Tom Billings
Hi, Just to support the

Hi,

Just to support the below comment.  MicroCLAVE is a neutral displacement device that can be used saline flush only.  It certainly fits the recommendation from Bard.  Clave is a minimally negative displacement connector with displacement of up to 0.02cc.  This volume decreases to virtually 0.0 after a few actuations as the silicone seats inside the device.  Corporately, we are pursuing validation of Clave for this PICC.

Happy Holidays to all!

-Tom

pcarruth
Tpa infusion

 Looking for literature to support tPa infusion. Rewriting CVAD care and maintenance policy.

JackDCD
Hi Tom,

Hi Tom,

 

We just switched to a positive pressure cap on our Bard Solo Piccs. At first I was wondering how that doesn't affect the valve, but according to the rep you can use neutral or positive. In your findins, do you see any adverse effect using either type of cap?

 

Jack

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