clc 2000 to clamp or to not clamp?

[MsRehabRN]

Hello all,

I was wondering what your policy is regarding clamping the catheter on the CLC 2000 ports after flushing. Do you clamp or not. If you clamp, do you clamp during the flush or complete the flush then clamp?

I was recently on the manufacturers website and it appears our unit is incorrectly managing these lines and increasing the opportunity for catheter occlusion.

Thanks in advance.

[K+MgSO4, BSN]

This is the CLAVE Product?

The CLC 2000 should not be clamped. My hospital recently changed to these so we had inservices on them. The rep states that they are a positive pressure device that is pointless to clamp them. They also eliminate the need to hep lock.

[iluvivt, BSN, RN]

You always need to know what kind of cap you have on your VAD.....negative neutral or positive displacement ( those are the 3 types on the market today.) You have a positive displacement cap so here is your sequence for flushing and I will explain why

1. Flush like you normally would current research shows a nice even study flush is best..there is NO research showing a push pause (pulsatile ) is the way do go but many are still doing this. I am happy if they would just flush after use

2 then disconnect ( it is in the disconnecting that the PD cap does its job as there is a spring mechanism in the cap that upon disconnect that is a positive displacement of fluid at the distal end of the catheter and blood does not reflux back into the catheter...so if you clamp and disconnect you bypass this function and defeat the whole purpose of using that type of cap

3. You can clamp after that the cap has done its job it is NOT contraindicated at that point

So in a nutshell Flush,disconnect then clamp in that order

Now if you have a negative displacement cap you have to perform positive end pressure flushing..that is flush and with approx 1/2-1 ml in they sryringe keep pushing while disconnecting

..yes it takes practice and is a bit messy. The purpose is the same..preventing reflux into the distal end of the catheter...what happens with that.......occlusion and increased risk of infection

once you complete your flush it is wise to clamp any catheter that has one ( open ended non-valved). If the cap should come OFF your pt could get an AE (air embolus) and could lose a lot of blood. What is important is when you do it..what sequence based on the type of cap . Clamps are there for a good reason..use them...if you ever saw someone code and die from an AE you would not hesitate....I do not clamp the PIVS routinely I am just talking about any CVC with a clamp

Recently PD caps have come under fire for increased infection risk (mechanism in many of the caps can trap bacteria, as well as cap design ) . Manufacturers are responding with new designs. There have been a few studies

Does that help?..can explain more if needed....you need to bring it to the attention of your nursing staff b/c these caps are not cheap and if not used properly you are just wasting that feature and are probably using more Tpa than you have to

By the way positive pressure is NOT the correct terminology and many get this confused the fluid is just positively displaced . Lynn Hadaway wrote an article in the INS journal a few mos back about cap technology and proper use and she explains this very well

[MsRehabRN]

Thank you both for taking the time to answer! That helped clarify things.