Question about broviac! Urgent please HELP!

[dcnurse789]

I did a teach and train for a family the was recently d/c with small child that has a broviac and requires hydration at home. When I told them to pull back to check for blood flow they told me that they were specifically told not to check for blood return when the hospital trained them? Is this common or is it doctor preference? Is there a reason not to? Thanks for your help!

[Rose_Queen, BSN, MSN, RN]

What does your facility policy state? It likely has references as evidence.

[offlabel]

Was drawing back for the purpose of wasting the in-line heparin? I could see that being the case so that the patient didn't get bolused with a lot of heparin when the line was accessed. There is no danger in assessing whether or not the line draws prior to using it as long as the blood is flushed out after use. Perhaps that is for the lay care giver not understanding the implications of blood draw through the line. Either way, if the line flushes easily, it doesn't matter if it draws or not.

[IVRUS, BSN, RN]

Was drawing back for the purpose of wasting the in-line heparin? I could see that being the case so that the patient didn't get bolused with a lot of heparin when the line was accessed. There is no danger in assessing whether or not the line draws prior to using it as long as the blood is flushed out after use. Perhaps that is for the lay care giver not understanding the implications of blood draw through the line. Either way, if the line flushes easily, it doesn't matter if it draws or not.

Again, this is definetly a wrong thought process... If this central line flushes without resistance, but does NOT yield a blood return, you have a NON-Functioning Central line which needs assessment and intervention. One post alluded to checking your agencies P&P... true. Some HHA only have the nurse checking for a blood return each time they come to do a dressing change.

[MunoRN, RN]

A central line that lacks blood return is not a "non-functioning central line", it's a functioning central line that lacks blood return. Lack of blood return is certainly something that needs to be addressed as it has been linked to an increased risk of CLASBI, but if the family isn't going to be the one treating a catheter without blood return or if the HH staff are not going to be making an immediate unscheduled visit to treat the lack of blood return, then having family aspirate probably does more harm than good. Suboptimal flushing techniques can lead to lack of blood return and complete occlusions, and as well meaning as a family might be, it's unlikely their flushing will be as reliable as that of a well trained RN, so having them aspirate when there is nothing that would come of that assessment is more risk than benefit.

[KelRN215, BSN, RN]

We don't teach our patients/parents to check for blood return when flushing central lines at home.

[IVRUS, BSN, RN]

A central line that lacks blood return is not a "non-functioning central line", it's a functioning central line that lacks blood return. Lack of blood return is certainly something that needs to be addressed as it has been linked to an increased risk of CLASBI, but if the family isn't going to be the one treating a catheter without blood return or if the HH staff are not going to be making an immediate unscheduled visit to treat the lack of blood return, then having family aspirate probably does more harm than good. Suboptimal flushing techniques can lead to lack of blood return and complete occlusions, and as well meaning as a family might be, it's unlikely their flushing will be as reliable as that of a well trained RN, so having them aspirate when there is nothing that would come of that assessment is more risk than benefit.

AND if it does NOT yield a blood return, it is NOT functioning as a central line needs to, and therefore for all intents and purposes, is non-functioning. A nurse should never ignore this, and yes, I agree, a homecare patient isn't the one to be assessing this.

[dcnurse789]

Thank you guys for the info!