What solutions are being infused in the port? Cathflo will not remove lipid sludge. As long as the port flushes I use Cathflo as prescribed. If I can not get a blood return after 2 attempts, then I consider requesting a dye study. A lot depends on what solutions are being infused in the port as well. INS Standard 56 is a good reference to this question. Hope that helps. Valorie
A chest xray first will rule out malpositioned tip location which could contribute to the lack of a blood return. There are no recommendations for which comes first, alteplase first vs contrast injection. I know that hospitals will use either as the first step. As Valorie said, you must do a thorough assessment of what led up to the problem to ensure that the likelihood of your obstruction being caused by thrombotic occlusion is high. If you suspect other causes, then alteplase will not solve the problem. Lynn
Thank you for you input. I just recently had an issue of pt. going into resp. distress after declotting her port. The cathflo and blood were aspirated then flushed with 20ml normal saline. Immediately she complained of her head feeling "funny" and began having trouble breathing. She then had a panic attack on top of all the rest. She was OK after some IV Ativan. A CTA wasn't done as she had an allergy to IV contrast. After talking to a Vascular surgeon, I am leary of declotting a port. He told me that we should not be solving a physican problem. He stated that there could be a large fibrin tail or thrombus on the end of the catheter that could possibly break loose causing a PE. Therefore, the only way to know would be to do a dye study. Do you have any information regarding the risks of this procedure having an unfortunate outcome? What is the evidence that this practice is safe for IV nurses to perform? Thank you in advance. I have been an IV nurse for nearly 20 years and this whole situation has me questioning this practice.
The risk for declotting an implanted port is no greater than any other CVAD. So I am not quite sure why the concern. I do not agree that this is a "physician problem". I do believe that it is most likely the case that you are dealing with a fibrin tail or thrombus at the tip in most cases of what we think is lumen occlusion. We do not have good data on numbers of occluded lumens vs vein occlusion though. Fibrin sheaths are going to be present on all CVADs and they strip off when the catheter is removed and do not generally produce any type of embolism issue. Thrombus could also be broken and embolize with any CVAD upon removal. So should we force physicians to remove all CVADs? Don't think so. INS Standard 56 Catheter Clearance: Occluded CVADs, page S76-77 establishes thir as within the scope of nursing practice. The patient's anxiety could have caused the funny feeling and trouble breathing. So the panic attach was inclusive of these signs and symptoms and not a separate event, according to what I read from your note. It all comes down to what your hospital policy and procedure states the nurse can and should do. See the list of 22 references for all catheter clearance procedures in the INS standards page S77. Lynn
What solutions are being infused in the port? Cathflo will not remove lipid sludge. As long as the port flushes I use Cathflo as prescribed. If I can not get a blood return after 2 attempts, then I consider requesting a dye study. A lot depends on what solutions are being infused in the port as well. INS Standard 56 is a good reference to this question. Hope that helps. Valorie
Valorie Dunn,BSN, RN, CRNI, PLNC
A chest xray first will rule out malpositioned tip location which could contribute to the lack of a blood return. There are no recommendations for which comes first, alteplase first vs contrast injection. I know that hospitals will use either as the first step. As Valorie said, you must do a thorough assessment of what led up to the problem to ensure that the likelihood of your obstruction being caused by thrombotic occlusion is high. If you suspect other causes, then alteplase will not solve the problem. 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
Thank you for you input. I just recently had an issue of pt. going into resp. distress after declotting her port. The cathflo and blood were aspirated then flushed with 20ml normal saline. Immediately she complained of her head feeling "funny" and began having trouble breathing. She then had a panic attack on top of all the rest. She was OK after some IV Ativan. A CTA wasn't done as she had an allergy to IV contrast. After talking to a Vascular surgeon, I am leary of declotting a port. He told me that we should not be solving a physican problem. He stated that there could be a large fibrin tail or thrombus on the end of the catheter that could possibly break loose causing a PE. Therefore, the only way to know would be to do a dye study. Do you have any information regarding the risks of this procedure having an unfortunate outcome? What is the evidence that this practice is safe for IV nurses to perform? Thank you in advance. I have been an IV nurse for nearly 20 years and this whole situation has me questioning this practice.
psb55
The risk for declotting an implanted port is no greater than any other CVAD. So I am not quite sure why the concern. I do not agree that this is a "physician problem". I do believe that it is most likely the case that you are dealing with a fibrin tail or thrombus at the tip in most cases of what we think is lumen occlusion. We do not have good data on numbers of occluded lumens vs vein occlusion though. Fibrin sheaths are going to be present on all CVADs and they strip off when the catheter is removed and do not generally produce any type of embolism issue. Thrombus could also be broken and embolize with any CVAD upon removal. So should we force physicians to remove all CVADs? Don't think so. INS Standard 56 Catheter Clearance: Occluded CVADs, page S76-77 establishes thir as within the scope of nursing practice. The patient's anxiety could have caused the funny feeling and trouble breathing. So the panic attach was inclusive of these signs and symptoms and not a separate event, according to what I read from your note. It all comes down to what your hospital policy and procedure states the nurse can and should do. See the list of 22 references for all catheter clearance procedures in the INS standards page S77. 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