[cherricka]

Ok, here is my question, which of course I will find the answer quickly through work, but I thought another "new"IV nurse may need this information too. What do you suggest for the following. I have a new patient with a 3FR non-groshong picc line with a CLC 2000 cap (so we don't need heparin). I was not able to get a blood return,but it flushed easily. I called the center where she was suppose to have chemo the next day, to suggest that they may want to use Cath-Flo before her next treatment(I also told her PCP) She ended up in the hospital with something else, and did not make it to the chemo treatment. I called the discharge planner to see if they did anything about it, and to ask if they got positive blood return. She is getting back to me, but she told me that I shouldn't be concerned as long as it flushed easily. The lumen is so tiny (which she then told me that she keeps telling the doctors to put in bigger lines), that you won't always get a blood return, but that doesn't mean there is an clot.

My IV supervisor believes that this patient should automatically receive cath-flo if there is no blood return. This supervisor is very smart, and I respect them, I just would like to know the options out there. My instinct is to document that it flushed easily, that the cancer treatment center and her pcp have been notified, etc.

What would you all do to cover yourself leagally?

[Gail-Anne]

I think you have covered yourself fine by letting Dr and Cancer people know the situation. However, the chemo nurse should not be giving chemo through this PICC without blood return, regardless of what the Dr says. Did it have blood return initially? If so, it may have a fibrin sheath now (allowing flushing but no return). If that's the case, cathflo interluminal may not help. We sometimes use a 3hr slow drip of TPA for this. Of course it would need flouro first to confirm fibrin sheath. Unless Dr is willing to have fluro confirm catheter before each chemo treatment (which is not even reasonable unless only for 1 dose) this should be dealt with ASAP.
Why put in a 3fr? I always put in 4s for my chemo referrals. (peds is different of course)

[cherricka]

Gail- It turns out that this patient may have her PICC line pulled any way! I will find out on monday. I don't know what they were thinking by putting in a 3Fr. We can't do blood draws on anything smaller than a 3.8 Fr. So this poor thing has to endure another needle stick each week before chemo. She is also mentally retarded, and gets very upset with anything you do to her, the poor thing. I think they have seen such a decline in her since starting chemo, that they don't think it is worth it. (cancer is everywhere)
Thanks for getting back to me.

[Binkey]

Hello,

I believe a key question here should assess the way that CLC 2000 injection cap is being used.
The CLC 2000 injection cap works well to convert a open-ended IV catheter to one that requires a saline only flush. It is a positive pressure displacement injection cap, but it must be used appropriately to work. If you guys have been using them for awhile, then I'm sure that you know how to care for them, but for those who don't...
Most clinicians flush the catheter using positive pressure flushing techniques (Flushing it using small bursts of fluid and then clamping the catheter simultaneously as you push in the last 2/10ths of the solution) However, with the CLC 2000 injection cap the exact opposite is done. When this cap is attached, flushing it using the "bursting" technique is fine, but then the syringe must be disconnected and do not use all of the fluid in the syringe. I usually save 2/10ths then disconnect the syringe hub. after disconnection then the catheter is to be clamped. Also do not attach a second cap onto this injection cap. The importance with any needle-less injection cap is a good alcohol friction scrub before hooking up any syringe or tubing. (We do a 30 second scrub)
Hope this helps.