Clotted catheters

Specialties Urology

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We are having a rash of new patients who have not have permanent accesses placed who are having their catheters clot. Policy, personnel, and procedures have not changed. It is not only in our clinic but others around us and does not seem like it is one hospital placing them either. Some of the patients do have issues where we cannot use heparin during treatment, which does compound the problem - but some of these patients have no comorbidities that would affect this situation. Any one have any insight into the problem? Or experienced the same phenomenon?

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Curious. What catheters (brand) are prevalent in your area?

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We are having a rash of new patients who have not have permanent accesses placed who are having their catheters clot. Policy, personnel, and procedures have not changed. It is not only in our clinic but others around us and does not seem like it is one hospital placing them either. Some of the patients do have issues where we cannot use heparin during treatment, which does compound the problem - but some of these patients have no comorbidities that would affect this situation. Any one have any insight into the problem? Or experienced the same phenomenon?

You write about "clinic" - are those patients at home with IJ???

If you see a cluster of something it should be reported to the manager of the clinic and the medical director.

Sometimes the MD ordered citrate as an anticoagulant for the catheter if heparin lock solution is not possible. The question is - do they come to HD after placement and the cath is already clogged before using it for the first time? Or does it happen after a couple of times?

Also - IJ are notoriously hard to HD with as placement, pat anatomy and movement has impact on blood flow. In one hospital we had a bunch of IJ with bad blood flow issues and it turned out that they had a rotation with a new person putting them in. For whatever reason, the tips were in such a place that it was hard to pull and blood flow was bad despite pat repositioning. The MD repositioned some caths but it was a drag.

There were also cases were non HD staff used the HD temp catheters to draw blood or infuse antibiotics without anybody from nephrology knowing or permitting - needless to say that those caths ever got locked correctly and clotted quickly.

You guys should collect data and bring it up to management so that they can start investigating what is going on if this is truly new...

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You write about "clinic" - are those patients at home with IJ???

If you see a cluster of something it should be reported to the manager of the clinic and the medical director.

Sometimes the MD ordered citrate as an anticoagulant for the catheter if heparin lock solution is not possible. The question is - do they come to HD after placement and the cath is already clogged before using it for the first time? Or does it happen after a couple of times?

Also - IJ are notoriously hard to HD with as placement, pat anatomy and movement has impact on blood flow. In one hospital we had a bunch of IJ with bad blood flow issues and it turned out that they had a rotation with a new person putting them in. For whatever reason, the tips were in such a place that it was hard to pull and blood flow was bad despite pat repositioning. The MD repositioned some caths but it was a drag.

There were also cases were non HD staff used the HD temp catheters to draw blood or infuse antibiotics without anybody from nephrology knowing or permitting - needless to say that those caths ever got locked correctly and clotted quickly.

You guys should collect data and bring it up to management so that they can start investigating what is going on if this is truly new...

My guess is the OP was referring to AVG/AVF as permanent accesses, and not IJ vs. tunneled central lines.

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Yes, I meant IJ tunneled catheters, sorry for the non-specificity. I am not sure about the specific product as they have all different lumen capacities, I believe they are different brands. It seems like the catheters will run for several treatments, then after a week or so, they seem like flow is less and less and then they need to be replaced. Heparin is indwelled after each treatment as per policy, dressings and caps look untampered with. Thanks for the feedback, guys. Sometimes you just have to rant a bit and there is no easy answer.

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Specializes in Dialysis.

That has happened in my clinic before. We would get a wave of really crappy CVCs for no apparent reason. We started using tego capa and it actually became worse. Our medical director actually ordered heparin locks for all tegos. Like I said, no apparent cause. They would run fine for a few treatments, then start getting sluggish. And with the tight control over activase, we couldn't keep enough in stock to properly run our pts. We were only allowed to have 1 dose in stock per Davita. How effective is that??

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Specializes in Dialysis.

If you are using TEGO caps on the ports they need a 20cc NS flush after use and will sometimes occlude if you only use 10cc.

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I have found that catheter function is all about who places them. Is it an interventional radiologist, surgeon, etc who does them all the time or is it someone training? They may work at more than 1 hospital. Start tracking names & locations where the catheters are placed. Ifyou find a good one, try to stick to them. Your nephrologist may have to get involved to determine if there are any internal issues with the hospital(s). Are they flushing them after placement to verify function?

It sounds like if the function is gradually worsening, they are developing fibrin sheaths.

What about options for permanent access placement?

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Specializes in ICU.

Change the size of the catheters. We had some patients who would come from the hospital 3 days after port creation with tight catheters. There was even one when the hospital had to use activase on her 2 days after they put the cvc. Sent that patient to the vascular and apparently, they changed her cath to a bigger one. Now she runs with VP/AP of 120-140 BFR 400. It happens with pt who both have tego and no tego (blue cath covers).

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Specializes in Nephrology.

There was one time that most of our catheter patient's tunneled catheters don't seem to work properly. And we, the nurses were thinking if the problem was from a specific vascular access center where they got their catheters. If it comes to a point that we have to activase the patient on a frequent basis, we refer them again to the access center to get a PC exchange. Yes it is frustrating both for the nurses part and the patient's part but you have to have patience in explaining this situation to your patient. Always remember, if they're running their dialysis on a very slow blood flow rate, they're not gonna clean their blood well which is gonna show on their Kt/V and URR lab results, they will waste a lot of their blood because of too much clotting incidents, and of course overall they are not gonna get the best dialysis possible.

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Specializes in hemo and peritoneal dialysis.

We had a young woman that used to push drugs through one of her ports, and frequently came in with it clotted. Wada rush. Unfortunately, she is no longer with us. (:o(

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