Cathflow

Asystole RN · Jul 3, 2012

Yes..off label but you need to ask yourself "what harm will come to the patient if left in the catheter overnight". Label it properly and I would much rather do this then let someone work with the catheter that is not experienced. I have just seen too many catheter fractures. I do not routinely do this though...have only done it in certain situations .

There is "off label use" where a medication or item is used outside of the 510k approval and then there is simply justifying an invented practice for 100% nurse convenience.

"What harm could possibly come to the patient?" That is one of those phrases that makes me cringe for the patient.

At the last AVA meeting I was at the presenter was addressing the tendency of nurses to invent policies and procedures that suited their needs without grounding them in a standard of practice or well-designed and substantiated studies. The sheer volume of lawsuits and problems were astounding. The defense of "It was in our policy" is not a defense to practice outside of the standard of practice.

MunoRN, RN · Jul 4, 2012

So basically you are saying that there is no foundation of support from a professional health association, no approval from any entity, and no recommendation from any entity either?
BUT it is still OK because some guy online named MunoRN says so. Awesome.
That's a real defensible argument.

I don't think anybody based on their policies on the use of cathflo on me, my 3 year old doesn't even listen to me.

Based on the available evidence, I can see why some dialysis services such as the one at my hospital lock with cathflo after every third treatment, why Lynn Hadaway recommended cathflo as an alternative locking agent to heparin at an AVA conference, and why home health leaves it in overnight when necessary.

Not only is there no evidence that there is a danger but there is evidence that it's safe, so I'm unclear on why you are suggesting that home health nurses should not tpa their lines?

I think you're misunderstanding the role of professional practice organizations. They are not regulatory agencies and don't define what can and can't be done. They also generally don't make recommendations unless there is conclusive evidence or rationale to support it, which is likely why you'll find no official recommendations on cathflo dwell time. Many policies exist on "scrub the hub" duration even though the INS makes no recommendation on this, should we tar and feather hospitals that advocate a specific scrub duration?

http://www.avainfo.org/website/download.asp?id=280460

There is "off label use" where a medication or item is used outside of the 510k approval and then there is simply justifying an invented practice for 100% nurse convenience.
"What harm could possibly come to the patient?" That is one of those phrases that makes me cringe for the patient.
At the last AVA meeting I was at the presenter was addressing the tendency of nurses to invent policies and procedures that suited their needs without grounding them in a standard of practice or well-designed and substantiated studies. The sheer volume of lawsuits and problems were astounding. The defense of "It was in our policy" is not a defense to practice outside of the standard of practice.

I don't agree that this is simply an issue of "convenience", it's a matter of this getting done vs not. There are scarce healthcare resources, particularly in home health. If a Nurse has to stay at home for an extra 2-4 hours, that means other patient's won't get seen that day, potentially harming other patients and essentially stealing resources from the system, which means you better be able to justify that, yet so far you don't seem to have provided any justification.

I'm well aware that many policies are bogus, which is why I always cringe when someone posts a question on AN and are told to check their own policies; the best way care for an IV site doesn't vary based on time zone, there should be one best answer. I don't however agree that professional practice recommendations are always based on good practice or an evidence base. The INS recommends changing secondary lines every 24 hours which goes against the evidence and is not considered good practice by the majority of policy makers.

I'm well aware that there are some groups out there (the INS and Lynn in particular) that have resorted to bullying and scare tactics to try and cobble together some degree of legitimacy. But in reality, professional practice recommendations are not automatically standards of care, even though they might like them to be. In general, practitioners follow practice organizations because they establish themselves as reliable sources of standards and practitioners will naturally seek out good standards, if they have to go around strong-arming practitioners into following their recommendations, there's a problem.