[stonecat6]

CVL's are always fun - but one advantage you do have with them are the extra ports. Unlike other lines that usually have less ports. If you have re-positioned the patient, flushed, and tried the cathflo and the line is still sluggish - naturally you also have checked your insertion site (right?) - If you are still getting blood return I would just leave it alone, and continue with flushing it 10cc saline every 8 hours; if there are meds being given, or blood draw flush with 20cc saline - make sure not to flush all the way to the end of the hub to maintain positive pressure !!! It is important to maintain positive pressure in the line, at all times. If there is no blood return, then I will consider calling your IV team for a consult on replacing the line - they can just thread one on-top of the existing line (or at least this is a possibility)... It is good practice to not use a line where you cannot get blood return from -

Plaque develops in the line, this is why it gets sluggish. Heparin is not good to use in clot busting - most of the time it is not a clot that has developed in the line, but fatty deposits. Saline is the best flush agent, and you cant increase frequency of flushes to q4h upto 20cc. Again keeping in mind to stop flushing at the 2cc or 1.5cc mark to maintain positive pressure.

I hope this helps.

Jasmine

[surferbettycrocker]

i see some posters saying to use heparin. what is the pt is positive for HIT?

[stonecat6]

Continous heparin flush can actually cause HIT in patients - more than not flushing with heparin. This is why the practice is discourage... Heparin Lock however is used on Portacaths, and stongly adviced. Just think about it, if you are to get an IV dose of heparin 10cc every 8 hours in 3 ports that would be 30cc of 1/1000cc heparin. This is assuming that the nurses only did flush once with heparin on that shift. Since the protocol of the hospital is to flush with heparin more than likely it has been used more than 1X.

[carebearRN08]

What do you folks think about a possible erosion of the vein? I am a new nurse and scared about doing anything that will cause further harm to the patient (of course who isn't?) and I remember reading in my critical care skills book that sometimes the catheter can wear away the lumen of the vein and cause an erosion. If this happens, the distal port will be blocked and you won't get blood return or be able to flush it. Now lets say we keep flushing with saline, then heparin, then get an order for Cathflo, we're doing all these things and just ruining the poor vena cava. We could even cause a patient to bleed out in this case.

Has anyone ever heard of a vena cava erosion or extravasation of a central line or is this extremely rare?

[IVRUS]

Originally Posted by carebear9904

What do you folks think about a possible erosion of the vein? I am a new nurse and scared about doing anything that will cause further harm to the patient (of course who isn't?) and I remember reading in my critical care skills book that sometimes the catheter can wear away the lumen of the vein and cause an erosion. If this happens, the distal port will be blocked and you won't get blood return or be able to flush it. Now lets say we keep flushing with saline, then heparin, then get an order for Cathflo, we're doing all these things and just ruining the poor vena cava. We could even cause a patient to bleed out in this case.

Has anyone ever heard of a vena cava erosion or extravasation of a central line or is this extremely rare?

If you are asking "Can a Central line infitrate?" then the answer is YES,
However, keep in mind that though the vessel wall can break down, allowing for the permiability of infusates to leak out of the vein, or the vessel may erode through the wall, it isn't an every day event.
Why? Well the SVC (where catheter's that are centrally placed terminate) is a large vessel that receives blood from the subclavian vessel which has a blood flow of approx. 2L/min. Therefore, vesicant medications (those that do the most damage to the tunica intima) are diluted quite well which helps to protects these smooth endothelial cells.
However, you do not have that same blood flow in your distal extremities and the injury to those cells intensifies with the extremes in pH or osmolarity of your infused med.
In over 20 years of Nursing, I've never had a Central IV catheter blocked because it has eroded through the vessel and I'm "steadily" instilling a fibrinolytic agent" causing further damage to the vessel.
Stay inquisitive and remember that a "healthy fear" will aide in preventing mistakes.