Developing Declott Competency...help please

[WineCountryRN]

SOS to the Infusion Nurses and Clinical Educators:typing

Just wondering if you have a Declot competency that you would be willing to share? We use Cath Flo (great free inservice materials provided by company) and I am working on competency for RNs.

So far I have the folloiwng competency criteria

1. Review Policy and procedure for Central Lines
   
2. Acheive 90% or better on Catheter Management Self Assessment (computer based learning)
   
3. Demonstrate proper set up for 3 way stopcock procedure
   
4. Identify proper amount of Alteplase to use based on cath size & number of lumens (or I could do weight for peds population)

What else to add for the psychomotor component?

Any ideas ?

Annie

[iluvivt, BSN, RN]

You need to add to the Tpa component...successfully prepares Tpa using proper diluent (2.2ml SW) and does not shake to reconsitute...also what about the syringe technique...then add selects appropriate syringe size(10 ml). Also add Properly identifies that catheter has Tpa instilled. Since Tpa has a dwell time up to 2 hours,the lumen (s) should be labeled to prevent use. In your checklist under assessment you should include an assessment component for the RN that includes to obtain a history of the catheter and its use to rule out non-thrombotic occlusions,including mechanical problems. For example if the nurse has just administered some bicarbonate followed by a very acidic drug,the occlusion is most likely a precipitate. Also include to obtain MD order if you do not have a standing order. Also include...documents on the Mar and nursing record the assessment of the catheter...actions taken...and the outcome of the Tpa. Include...repeats dose if initial dose unsuccessful and thrombotic occlusion is still suspected. Sorry I did not put this order but ideas just keep coming to me