[cpr4life]

Are any of you giving Cathflo in the home setting?

I believe it is safe. Do you?

If you are giving it in the home, have you had any problems/complications?

My mom is receiving PICC infusion of Vanco and has had Persistent Withdrawl Occlusion (PWO) twice in three weeks.

Her Home Health RN's won't give Cathflo in the home setting due to facility policies. I must drag Mom into the hospital and wait in ER or at the infusion center waiting room (she is unwelcome in the infusion center due to a MRSA osteomyelitis) for them to treat with Cathflo. She's very elderly and this is hard on her. (It's also time consuming for me and frustrating because I give Cathflo at work all the time!)

I'm an RN and know that Cathflo is a routine part of PICC maintanance. Everything I've read so far leads me to believe that the benefits of giving Cathflo outweigh the risks. (I read that there are very few cases of side effects.)

I believe it's a case of "we've never done that therefore we don't do it". Trouble is it's my Mom that suffers while we wait for our provider to evolve their home nursing services!

Any help is appreciated!

[dhyser96]

I imagine it really is a P&P issue. But I have given it in the home without any problems. I pick up the Cathflo and stopcock at the local critical care supply place and take it to the patient's home to administer it. Maybe there is another HH agency in the area that could supply that service to you? Or even the infusion supply company - do they have any nurses that could administer it?

[cpr4life]

A private agency is being looked into. It's definitely a P&P issue. It's nice to hear you've never had any problems giving it in the home! We need more Hm Health Agencies to get the training and begin rewriting their policies!

Thanks.

[PICC ACE]

Of course it's safe,both in home and hospital. Here's a good article you might be interested in,for yourself or for the HH staff.

The Use of Alteplase for Treatment of Occluded Central Venous Catheters in Home Care by Nancy Moureau, BSN, CRNI, Lisa Mlodzik, BS, PharmD, CGP, and Susan Markel Pool, BSN, CRNI, CNSN Description
The purpose of this trial was to confirm safety and efficacy with thrombolytic use on complete and partially occluded central catheters using alteplase for the home care population. This trial attempts to provide additional evidence for the safe and effective use of a thrombolytic agent for catheter clearance, specifically with home care patients. Patients were eligible for inclusion if (1) blood could not be withdrawn for partial occlusion or (2) blood could not be withdrawn and inability to flush presented with complete occlusion. Through an established protocol, using the negative-pressure technique, nurses administered alteplase, 1 mg/1 cc concentration, to home care patients who met inclusion criteria. Instillations were repeated at 20-minute intervals for up to three repetitions, if needed, with the third instillation remaining overnight. Instillation of alteplase was successful in clearing catheter thrombotic occlusions in 66.7% of patients studied in this outpatient population without thrombolytic events or drug related adverse effects. The authors confirm that catheter occlusions can be safely resolved in the alternate care/home care setting using established negative-pressure protocols. Although overnight dwell was used successfully and unsuccessfully in this trial without adverse effects, the small sample size does not provide adequate definitive conclusions.
Full article found in Fall 2005 JAVA. Good luck.

[cpr4life]

Wow. This is perfect! Thank you so much for the reference. I will look at our hospital library to see if I can get the article for free.

The JAVA wants $10 for the one article which it is worth to me if my Mom's provider would do Cathflo in the home!

I know Cathflo is safe- it's a naturally occuring enzyme in our bodies but changing the policies of a huge institution such as Kaiser is another story!

Again, thanks a million. I searched google last night and found a lot of articles about PWO and Activase but none specific to the home care setting!