Rn, Crni

[rnatfahc]

hello,

i am an infusion nurse specialist in a 500 bed hospital. our team places picc lines as well as pivs for pt.s in almost every unit. we have found an increase in the number of clotted lines that need to be treated with tpa. ( a very expensive treatment for something that should be preventable) at any rate, our policy states that we only tpa picc lines or long term tunnelled catheters and that other acute catheters, if clotted, should be re-threaded. i wonder if any one out there has any data supporting this policy. we need evidence based practice especially to convince the dr.s. our policy also states that we use saline only for flushes and heparin only if specifically ordered. this change was made in response to incidences if itp or dic r/t heparin. also is there any info on the use of tpa on infants?

[Tweety, BSN, RN]

Welcome. This forum is primarily for introductions and you probably won't get many responses. Try posting your question in the general nurses section: https://allnurses.com/forums/f8/

Or the Intravenous Threapy section: https://allnurses.com/forums/f27/

You also might try your local nursing school and ask if they have a library you can use, or an organization of IV nurses website such as: http://www.mdins.net/sharedresources/venifacts/venifacts.htm

Good luck.

[suebird3]

Welcome to allnurses.com! I moved your post to the IV Nurses Forum for better exposure.

Suebird

[sunnymqt]

We have had more clotted PICCs lately. We have always used the PASV valve and saline. We recently change to the Purple Power PICCS andm have noticed more clotting problems.

Does any one have a good system with saline flushes only???

[Binkey, BSN]

We have had more clotted PICCs lately. We have always used the PASV valve and saline. We recently change to the Purple Power PICCS andm have noticed more clotting problems.

Does any one have a good system with saline flushes only???

The Purple Power PICCs are open ended IV catheters which require Saline and Heparin to maintain patency. However, if you are using an injection cap such as the CLC 2000 (an injection cap that converts an open-ended IV catheter to one that needs a saline flush only), one must use it in the proper way it order for it to work.

ie... When using this positive pressure injection cap, flush your line with saline using positive pressure flushing, but instead of clamping before removing the syringe, one must remove the syringe and then wait ten seconds and then clamp. This cap is designed so that when the syringe is removed, it forces fluid out the end of the IV catheter, thus dissallowing a reflux of blood. If it is clamped before the syringe is removed.. It "can't do its do" I teach my students to flush the line, but leave approx 2/10 of a CC in the syringe, then disconnect. It helps when you don't allow the barrel of the syringe to come into contact with its end.

Hope this helps.

DD

[patientfirst]

We have had more clotted PICCs lately. We have always used the PASV valve and saline. We recently change to the Purple Power PICCS andm have noticed more clotting problems.

Does any one have a good system with saline flushes only???

Sunny, hello, as the venous access experts at our hospital we owe it to our patients to choose the correct line for them. A stiffer, clamped catheter that relies on an end cap that has to be changed at least weekly is not the safest line to send our patients home with. We also use the PASV line and it's the safest for our patient's. There is an indication for a PowerPICC, but it is few and far between. Give me a line that's been proven not to clot off or get infected as often as a clamped PICC and I'll put that line in my patient any day. With the PASV valve built into the catheter we don't have to worry about our nurses on the floors having to worry about when to clamp the PICC. Our valve in our PASV PICCs is our clamp.

Always remember, we are the experts and our patients deserve for us to choose the best care!

God Bless!