Milrinone drip how to declot noncontinuous ports

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Question: patient has a triple lumpen pic with continuous milrinone drip. The line running milrinone is patent but other lumens are sluggish/occluded. Can you leave milrinone drip running while declotting other lumens with cathflo?

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Specializes in Critical Care and ED.
Question: patient has a triple lumpen pic with continuous milrinone drip. The line running milrinone is patent but other lumens are sluggish/occluded. Can you leave milrinone drip running while declotting other lumens with cathflo?

No, I would not do that. If any of the cathflo gets into the patient you have a potentially catastrophic event on your hands and you will be liable. Cathflo should only be used on lines that are not currently running a medication. Why take the risk?

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Thank you for your advice! This patient is in a home health setting and would need to be hospitalized, have the milrinone drip moved to an alternate site to keep running in order to declot the other lumens then is what you'd suggest?

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Specializes in Critical Care, Capacity/Bed Management.

error.

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Not sure I agree with the idea that the patient getting the Alteplase systemically is that big of an issue as the half-life is really short and it does not affect platelets but I could be wrong. What stands out to me is that if two of the three lumens are clotted then the third one is likely on its way to being the same and then the Milrinone infusion may be interrupted. It is our policy (and our rep recommends this) when we declot PICC lines we use Alteplase in all lumens (regardless of blood return)because the opening of the lumens are in the same place. So if one has a clot or tail the other(s) probably have them same thing happening. Best to start another line and run the Milrinone in that while the PICC is being worked on.

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Specializes in Critical Care and ED.
Not sure I agree with the idea that the patient getting the Alteplase systemically is that big of an issue as the half-life is really short and it does not affect platelets but I could be wrong. What stands out to me is that if two of the three lumens are clotted then the third one is likely on its way to being the same and then the Milrinone infusion may be interrupted. It is our policy (and our rep recommends this) when we declot PICC lines we use Alteplase in all lumens (regardless of blood return)because the opening of the lumens are in the same place. So if one has a clot or tail the other(s) probably have them same thing happening. Best to start another line and run the Milrinone in that while the PICC is being worked on.

It's a HUGE issue. This medication has life-threatening risks and is only given systemically in an emergency...basically in active MI. It's a tissue plasminogen activator that is higher up in the clotting cascade than a platelet inhibitor. There is also no antidote. Don't do it! If the patient has an active med running through that line do not instill it. Does she become unstable when the milrinone is held?

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It's a HUGE issue. This medication has life-threatening risks and is only given systemically in an emergency...basically in active MI. It's a tissue plasminogen activator that is higher up in the clotting cascade than a platelet inhibitor. There is also no antidote. Giving this to a patient in an outpatient setting is an absolute contraindication. Don't do it! If the patient has an active med running through that line do not instill it. Does she become unstable when the milrinone is held?

We use this in the outpatient setting all of the time. The dose used for de-clotting is miniscule and is not considered a huge risk at all.

FAQs | Cathflo® Activase® (alteplase)

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Specializes in Oncology.
No, I would not do that. If any of the cathflo gets into the patient you have a potentially catastrophic event on your hands and you will be liable. Cathflo should only be used on lines that are not currently running a medication. Why take the risk?

The lines not running are separate lines and should be treated as such. Of course you can cathflo the lines not in use while a med in running in a different lumen. A touch of cathflo getting systemic isn't catastrophic. It's a minute amount with a short half life.

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Specializes in Critical Care and ED.
The lines not running are separate lines and should be treated as such. Of course you can cathflo the lines not in use while a med in running in a different lumen. A touch of cathflo getting systemic isn't catastrophic. It's a minute amount with a short half life.

I absolutely and categorically disagree but on your own license be it. I would not do it.

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Specializes in Oncology.
It's a HUGE issue. This medication has life-threatening risks and is only given systemically in an emergency...basically in active MI. It's a tissue plasminogen activator that is higher up in the clotting cascade than a platelet inhibitor. There is also no antidote. Giving this to a patient in an outpatient setting is an absolute contraindication. Don't do it! If the patient has an active med running through that line do not instill it. Does she become unstable when the milrinone is held?

She's not talking about putting cathflo in the line with the milronone running in it. She said that one is patent. She's asking about the other lumens, which would be treated as separate lines. She's not using tpa systemically, even though the 2mg used for line patency would do nothing systematically.

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I absolutely and categorically disagree but on your own license be it. I would not do it.

Read the link I posted. Trying to understand your point of view as you seem very passionate about it.

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Specializes in Oncology.
We use this in the outpatient setting all of the time. The dose used for de-clotting is miniscule and is not considered a huge risk at all.

FAQs | Cathflo® Activase® (alteplase)

We have patients use it at home even

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