what is your policy when central line won't allow blood aspiration? - page 2

I was talking to a colleague about whether or not she uses a central line port for meds if she is unable to aspirate blood. I must have grown an extra head. She looked at me like I was nuts. I was... Read More

  1. by   endorphinrush
    In my unit most of the pts are on vents and get a CXR q am. I always pull up my CXR report as well as the CXR itself. For a long time, our hospital used a contract PICC team of which I was fortunate to be a part of. we have a standing order that we can use activase to clear our ports if they do not have a blood return. I am not sure if it applies to regular CVL's though. I'll have to look. We are getting away from CVL's and using PICC's more and more though. Cheaper and less risky. Fibrin sheaths will build up if the lines are not flushed properly and regularly though. A common misconception that many nurses have is "My line is infusing so I don't need to flush it." Yea, you do. It goes a long way in helping maintain your patency.
  2. by   daniw603
    I agree with Binkey. If appropriate, and an Alteplase order can be obtained, this will help dissolve the fibrin sheath. It would be nice to have the line for labs available if needed, anyway. In most cases, if the established line has been cleared for use via x-ray, it is probably only fibrin. But things happen to lines all of the time, (I work on a Bone Marrow Transplant and Oncology critical care unit, and 100% of our patients have some type of CVC, if not 2 or 3.) Bottom line- what risks are you willing to take, what is the worst possible outcome of pt. getting or not getting the drug? what do you know about the drug- is it an irritant and what will it do if it goes somewhere besides the vascular area? Many experienced RN's have years of good luck- It's how you practice- what would you do if it were a loved one in that bed? Use your judgement. Nursing is not black and white...