Recently (for about the past 6 months), our PICU and general peds floor have seen a huge increase in ruptures/clotting of Broviac lines. Within the past month in the PICU alone, we have had four separate Broviacs on three separate patients placed by two separate surgeons all end up clotted and/or ruptured (all were ruptured, some were clotted as well). We've also had issues with lines becoming clotted or not drawing back, despite being in the correct location.
Now, it's possible the Broviacs are rupturing because they are clotting and the attempts to force-flush the line (which should never be done) are causing breaks. But that raises the question- why are they clotting?
Our central line protocols have not changed at all. Our policy is to run a potency solution (Normal Saline with heparin 1 unit/mL at either 3 or 5 mL/hr) continuously through the line. The only thing we have changed is the pumps on which we run the potency solution when it's ordered for 5 mL/hr. (We changed from Baxter pumps to Sigma pumps for medication delivered via bags. Due to the volume of fluid needed, rates of 5 mL/hr are dispensed from pharmacy in a bag, while rates of 3 mL/hr are dispensed in syringes and run on syringe pumps.) But the change in pumps does not account for all of the patients who ruptured.
The only other thing we could think of is that there has been some sort of manufacturing defect on the part of the Broviac company recently that hasn't yet come to light. Some of these Broviacs didn't even last a week after placement.
So I'm asking other PICU nurses- have you noticed an increase in complications with your newly placed Broviac catheters in recent months? Do you have any ideas about what might be contributing to our unit's problems or suggestions for improvement?
Jul 21, '12
Let me ask you a few questions..........Are you also flushing the lines with either NS or heparin on a schedule and especially after medication or just depending upon your a basal rate to keep the line open? When you have a PWO (persistent withdrawal occlusion) how are you treating this and when?
Jul 22, '12
I would tend to think that there is a defect in the lines since you haven't changed your practice. Do they keep the packages so that they can run the lot numbers and see if there has been a problem? We had a problem like that with some PICC lines a few years back and it turned out to be a manufacturing defect. Is it happening within a certain time frame?
Jul 23, '12
We flush the line with NS or a compatible fluid after each medication administration. We don't currently have a policy for hep-flushing on a schedule. This might be something to consider, though. Thank you. When we discover that a line will not draw back or flush, we use TPA, 2mg in 2mL, instill it in the line and leave it for a few hours. The TPA should be instilled as soon as possible after the problem is discovered.
I'm not sure if they keep the packaging or not, but I'd have to imagine the lot number is on file somewhere- maybe in the OR paperwork or for billing purposes. We've done some research and so far haven't found any info about manufacturer's problems. The lines that have been breaking tend to do so in a relatively short period of time. A few were not working within 48-72 hours after insertion.
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