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Leann Kennedy
Your staff and Cathflo

I was wondering...which of you out there allow IV RNs only to instill Cathflo or have P & Ps allowing any staff (with competency) to Cathflo a line?  I'm tring to get a rather large poll, so the more of you that reply, the better...thanks.

anna liang
staffs in the peds unit adm
staffs in the peds unit adm cathflor rountinely. but staffs in the audlt units don't 
pjean
Related to PICCs: charge

Related to PICCs: charge nurses (RN) in our facility with competency verification.  Still working on getting those trained.

KPater
As per pharmacy policy, in
As per pharmacy policy, in our institute, IV Team RNs, Critical Care RNs, and Chemotherapy Certified RNs can administer thrombolytic agents.  We are currently updating our policies to reflect the same, and we have created a competency.
lseaver
We have a patient with a

We have a patient with a portacath which we can't aspirate blood thru.  We reaccessed x 2 without success, and have done a dye study which showed a fibrin sheath.  Cathflo was used without success.  Am wondering if anyone has a order set or protocol for a cathflo infusion to get rid of the sheath.  I know I have seen it discussed on this listserve before, but we have never done any here, and was looking for information of doseage and potential complications, what monitoring needs to be done and for how long..........etc.  I appreciate any help.  Thank you. 

Patty Luptak
I wrote the protocol for the

I wrote the protocol for the Infusion at our hospital and have published a booklet as well. I would be glad to share it with you. Email me at [email protected]

Thanks

Patty

Marilyn Patterson
Any staff nurse with the

Any staff nurse with the competency.

gran77
We have a

We have a competency/learning module RNs must complete/be certified prior to using Cathflo. All certified PICC RNs in our facility act as resources when no other certified RN is available. This is applicable to our Critical Care Units, and the floors.

Frank Gran RNIII, Kaiser Medical Center, San Rafael CA

Frank Gran RNIII, Kaiser Medical Center, San Rafael CA

Chris Naylor
We allow RN's with

We allow RN's with competency to admininster Cathflo.

Chris Naylor RN, CRNI, Santa Rosa Memorial Hospital, Santa Rosa CA

Chris Naylor
We allow RN's with

We allow RN's with competency to admininster Cathflo.

Chris Naylor RN, CRNI, Santa Rosa Memorial Hospital, Santa Rosa CA

Jennifer Rabalais
We allow any staff nurse as

We allow any staff nurse as well as our home health RNs to use CathFlo after taking the inservice and passing the competency validation.  We have an experienced RN observe/proctor the first administration by a newly qualified nurse.

 

Jennifer Rabalais, CRNI, CIC

bekipope
We allow any RN to use

We allow any RN to use Cathflo.  But there is a down side.  It may be getting used too much as any RN is not good at eliminating other causes for occlusion, such as pinch-off

 

Jennifer MCCord, MSN, RN, CCNS

Bethesda North Hospital

Cincinnati, OH 

sesymons
We have yearly competencies
We have yearly competencies -catheter occlusion is one of them. Any RN with competency can administer. We have an occlusion policy which states RN can administer treatment though it does not specify RN with competency.
AMParry
At our Health System the IV

At our Health System the IV team administers Cathflo for all inpatients and most outpatients- they are informed of the problem, assess the line and administer the Cathflo.  We do have an occassional patient that gets Cathflo in our AIC

Ann Marie

Ann Marie Parry, RN, CRNI, VA-BC

[email protected]

rivka livni
Our PICC team are the only
Our PICC team are the only ones to use Cathflo. But i must say we rarely have occlusions. We insert only 50-70 PICC per month and use cathflo about 0-3 times a month. We insert ONLY POWER PICCs (5.0FR single lumen, 6.0FR dual lumen and 6.0FR Triple lumen) and no, we hardly ever have DVT. But most of our PICC don't stay in too long, average length of stay is only 28 days. We have had a few PICC stay over a year an a half with no occlusions. The nice thing about power PICC is they can be flushed much more vigorousely then non power PICC which takes care of the occlusion.
artiehansford
Artie Hansford, BSN,

Artie Hansford, BSN, CRNI

Rivka, do you use heparin flush for your power piccs or saline only and how often and what concentration and amont if heparin is used?  What type of injection cap are you using?  Thank you!!!!

Artie Hansford, BSN, CRNI, VA-BC

tinacrni
I am not sure what our

I am not sure what our hospital does.  I am in the outpatient infusion center and have we have our own policies.  Cathoflo in my opinion should be limited to those properly trained and this includes the administration with supervision x 3.  I feel that Cathflo could be over utilized if all nurses can use.

Being a CRNI, I think it woul be best to teach the nurses how to prevent occulsion, "pinch off syndrome" signs, etc.

Linda C Motley
IV Team (RNs) only
IV Team (RNs) only
Bud
My questions to those of you

My questions to those of you using cathflo -

how often is it being used?

and what is the percentage of in house PICCs that require declotting during their stay?

Thanks!

Bud Lavin, RN, CEN

Manager - PICC Team

St. Mary's Hospital

Passaic NJ

lavinb(at)smh-passaic.org

Bud Lavin, RN, CEN

Manager - PICC Team

St. Mary's Hospital

Passaic NJ

lavinb(at)smh-passaic.org

lisayrn
Lisa Y., Team Leader IV Team

Lisa Y., Team Leader IV Team UPMC St. Margaret Pittsburgh

 

IV nurses and chemo nurses who have been signed off by us.

Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy

Patti Atteberry
Any nurse that has been

Any nurse that has been education during orientation and annually can administer Cathflo. Our P&P states to assess the line, if no bld return or occluded then the patient is to reposition, try go hub to hub and if still not bld return or change in patency then this line is indicated for thrombolytic therapy.  We are in the Home Care setting.

Patti Atteberry, RN, CRNI
jdolalie
RN's only who are orientated
RN's only who are orientated to the procedure.
kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

I think the staff RN's should be part of the process whether it be educational or doing the procedure. 

The key is the definiton of what an occluded catheter varies from RN to RN.  An occluded catheter is one that does not give you 3cc of free flowing blood return and /or has sluggish infusion.  Most RN's do not even check blood return and infuse if they have no blood return.  But that is the definition of an occlusion.  It is not complete blockage as the definition.  I think we undertreat catheters just like we miss patients who were PICC candidates.  It goes back to understanding the process

 kathy

Kathy Kokotis

Bard Access Systems

lynncrni
Kathy, where is this idea of

Kathy, where is this idea of obtaining 3 mL of blood coming from. To my knowledge there has been no research or any evidence to identify this specific quantity to establish the fact that a catheter will provide a blood return. I have heard this in one other place but seriously question this idea. 

 

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

jordanhosp.IVT
We would not instill Cathflo

We would not instill Cathflo into a line that was giving a adequate blood return such as this.In our facility-on the MDs or IV nurses are allowed to instill the Cathflo..

Peter Marino
   http://www.gene.com/gen

 

 http://www.gene.com/gene/products/information/cardiovascular/cathflo-activase/insert.jsp#indications

CLINICAL STUDIES Three clinical studies were performed in patients with improperly functioning central venous access devices (CVADs).

Restoration of function was assessed by successful withdrawal of 3 mL of blood and infusion of 5 mL of saline through the catheter.

 

I have seen this somewhere else also. When I remember I'll post it.

 

 

 

[quote=lynncrni]

Kathy, where is this idea of obtaining 3 mL of blood coming from. To my knowledge there has been no research or any evidence to identify this specific quantity to establish the fact that a catheter will provide a blood return. I have heard this in one other place but seriously question this idea. 

 

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

www.hadawayassociates.com

[/quote] Staff R.N. with no affiliation to any product or health care company(your basic front line grunt/wage slave)

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

htshapiro
we are working on this in

we are working on this in our hospital.  Does anyone have a nursing competency/sign-off they'd be willing to share?  Please e-mail me- Thanks

[email protected]

jordanhosp.IVT
Thats a strange criteria...

Thats a strange criteria...

blacba
at our hospital oncology,
at our hospital oncology, ivt or ccu can cath flo.
bartina
Nancy Rose RN IV Team VA

Nancy Rose RN IV Team VA Medical Center Wilmington, DE (800) 461-8262 ext 4830

At our 60 bed hospital, IV Team (2), Oncology (2) and Hemodialysis nurses, all RNs, are the only ones de-clotting lines.

Nancy Rose 

Nadine Nakazawa
RE: Declotting

 We allow any staff nurse to declot:  they just need to follow the P&P.  If they fail after 2 doses, then the Vascular Access Service Team should be contacted by an "PICC Eval" order, and a brief description under comments as to the problem.  eg., "Unable to declot after 2 doses. Please evaluate."   We then order a CXR.  The vast majority of the time it's a dislodged PICC tip causing the catheter dysfunction.  We consider declotting to be a staff nurse responsibility.  More in depth evaluation is up to the VAST.

 

 

Nadine Nakazawa, RN, BS, OCN, CRNI, VA-BC

Karen Day
Karen Day's picture
Indications of a catheter

Indications of a catheter blockage

Indications of a catheter blockage

  • Lack of free-flowing blood return, even if the line flushes easily
  • Inability to infuse fluids
  • Increased resistance when flushin.
  • Sluggish flow*

*Sluggish flow is defined as lack of brisk, free-flowing blood return (<3 mL in 3 seconds).8

 

as per the recommendations for the use of cath flo on their website cathflo.com.  I think this is where the idea of 3ml of brisk blood return came from.  They used the following as a reference for this guideline:

Cummings-Winfield C, Mushani-Kanji T. Restoring patency to central venous access devices. Clin J Oncol Nurs. 2008;12(6):925-934.

 

 

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