alzrn

Thank you IVRUS. The crackling sound is alarming to me. Prior to this, I had never heard a port make any sound before. I'm surprised that my fellow RN's and the doctor's are so ...complacent, unconcerned, and not even curious as to why this is happening even though they admit that they have never encountered it before either. Patient has no pain with infusions, incision and port site looks good. Is currently self infusing at home TID (per doctor's orders...). That has made me question whether or not to trust my gut instinct here. If something is going on though, I don't want to wait around until the patient has terrible pain or irreversible symptoms. I would rather have a problem caught early so that the catheter might be repaired or port replaced if necessary. Before harm is done. I'll contact the surgeon to see if he'll be willing to order the dye study.

How do I get an order for a dye study? Does the surgeon usually order this? The doctors seem unconcerned because the port seems to be functioning so well otherwise. They are convinced that we are simply hearing it being flushed. Other nurses I have spoken with have never heard this crackling sound in a patient with a port. I was thinking of calling the port manufacturer (AngioDynamics) to see if I might be able to talk with a clinical specialist. Maybe they have heard of this occurring with some of their ports (it's a low profile Smart Port)? I'm curious to see what they will have to say. The crackling sound does not occur with every flush and every infusion. We are careful to push out the air and prime all flushes so it seems to occur only every now and then. That's what initially what made me wonder if it could be tiny air bubbles that caused the noises. Thanks

Have any of you ever heard a port make crackling sounds when it was flushed? This port is only a month old, was accessed in the OR, used for the first time that night. Crackling sounds were noticed with the first flush at home. The port is accessed with a 1/2in 22g needle. Can we be hearing tiny air bubbles that might be making the crackling sound? You can also hear the fluid flow as you flush it. So maybe the port is just very close to the surface? We get excellent blood return and no resistance with flushing or infusions. I've been told not to worry about the crackling. I'm still curious as to what could be causing it and if anyone else has ever heard it before in their patients. Thanks!

Has anyone else ever dealt with a problem like this?

I originally had a regular Power PICC. It had the same problem with reflux which lead to frequent occlusions. I used the positive displacement LAD that was recommended, disconnected after flushing, then clamped. The blood would still reflux up to the clamps. After several months of frustration they replaced the PICC with a double lumen Solo thinking that the valves would stop the reflux. The insertion was quick and seemed to be easy. I couldn't see anything because of the draping. So I can't answer about the stylet or wiring. We were disappointed when the reflux problem persisted. It occurs in both lumen, flows right up to the valves and stops, it doesn't go past the valves into the extension sets. At one point the PICC nurses recommended that I stop using the extensions. Then I could not self infuse, I always had to have a family member around to help me. When the reflux problem persisted I went back to using the extensions. Some days are worse than others. Yesterday I noticed 7 episodes of reflux (think of all the extra flushes this requires!). Sometimes it only happens once or twice. I don't check every hour or anything like that, just randomly when I think about it. My extension sets come with slide clamps (which I always throw away). I will open up a pack and try the clamps today just to see what happens. If it helps that would be a nice easy fix. Thanks again Iluvivt. I know I can't be the only person out there with this problem.

MunoRN, Thank you for reminding me, I have that nursing guide saved on my computer. Bard does recommend the push pause technique for flushing to help clear the valves. Maybe it is not necessarily the "push pause" action that causes the problem with shearing of biofilms but the excess force that some people tend to use with this technique? Iluvivt, the PICC is supposed to be a SOLO2. It was placed feb 22, 2011. They used ultrasound and sherlock tip location. The dressing was done before x-ray. No adjustments were needed afterwards. The reflux was first observed a few hours after placement, before it had been used for any infusions. The first occlusion occurred 3 days later. There have since been 6 more occlusions. Cathflo has been effective each time. Iluvivt, Thank you for taking the time to think about this issue and discuss it with your knowledgable colleagues. I really do appreciate it.

Thank you, I really do appreciate all your advice. I stopped using the positive pressure flush technique to allow the positive displacement LADs to work properly. I've also been using a smooth steady flush instead of the push-pause method. Unfortunately I am still seeing blood reflux problems. The reflux occurs while resting and sitting upright. I've watched it happen as I'm typing here at my computer. It is almost unbelievable to see. The blood flows right up to the SOLO valves but does not go past the valve. When I see this happen I always flush with 20cc NS and finish with 3cc 100u heparin. What do you think is causing this? I don't think the PICC is damaged. I observed this for the first time on the day that the PICC was placed, before I even used it. I shouldn't have been malpositioned then either. If I could stop the reflux I might be able to prevent the occlusions...

What does it mean when you get good brisk blood return but meet resistance or have a sluggish flush? Cathflo was recommended to restore function and it did so with one dose. Unfortunately the line remained patent only 1wk before the problem reoccured. Do you have patients where you've had to use Cathflo frequently?

Thank you iluvit and IVRUS. My experience has primarily been in peds med surg and ortho outpatient nursing. I have not had the opportunity to work with many PICCs until now! You've given me some good tips to consider. I had been taught to always use the push pause flush method to clear the line and the positive pressure flush technique while disconnecting. I never thought that this might negate the effect of the positive displacement cap. I will have to be mindful of this. I will also have to watch rest and sleep positions to make sure that the line is not being compressed. I can see how that would cause reflux. Have you ever had a patient with reflux while sitting or resting in semi-fowler's position? Do you know what would cause that (assuming patient is not actively vomiting or coughing)? When do you decide a chest x-ray is needed to confirm tip location? Only for suspected malposition or in the case of frequent occlusions also? Do you view the x-ray yourself or trust the radiologist's opinion that the tip is in proper position. It is quite disconcerting to think of the tip resting against the vein wall, especially when vessicant meds are being used. How would you assess for catheter fracture beyond what is visible externally? Wouldn't there be leaking at the insertion site or any other clues?

Hi, I'm new to this site and I hope that I'm posting this question in the right place. I'm an RN and I'm having a difficult time caring for my own PICC line. It is a double lumen Bard Power PICC Solo. I use MaxPlus positive displacement caps. The problem is, I have frequent spontaneous blood reflux that fills my lines. This has caused several occlusions (requiring expensive cathflo treatments) and I've only had the PICC in for about 4months. I am on twice daily antibiotics and IVIG. I have poor venous access so I need this PICC line. Do you all have any suggestions? Is there anything I can do to prevent the blood refluxing? It happens multiple times daily. I am careful to use the positive pressure flushing technique. The PICC line nurses at my hospital have not been able to figure out what is causing this problem. They say it shouldn't happen. I had another Power PICC with the same problem that was pulled and replaced for this reason, constant blood reflux and frequent occlusions. I would greatly appreciate any advice.