Uk, Tpa

[EricTAMUCC-BSN, BSN, RN]

What do you use to reverse coagulation of central line catheters?

[LCRN]

What do you use to reverse coagulation of central line catheters?

Hello-

I'm confused about the question...do you mean if a patient has elevated coags what product is used to "normalize"?

At my facility if someone has an elevated PT/INR we always give FFP based on the coags and then do the procedure within 1/2 hour after the infusion is completed. However if a patient has a "shocky" liver or has a clotting malfunction we opt to place a femoral line. The policy in our facility is that any lines (excluding IABP) that is placed in the groin has to be rotated or changed over a wire within 48 hours of insertion.

We have circumstances as all hospitals do that are "exceptions" to the rule. For example we had a CABG/MVR 76 year old male who went "bad" and had numerous lines that were not being rotated per policy--> R fem IABP, L fem art/venous sheaths, R IJ swan/TLC (both in same point of insertion) and a L SC shiley catheter for CVVH. On multiple vasopressors, ABX, diuretics and xigris all this with an open chest!!! Needless to say this was one of our few 1:1 patients.

What's procedure at your facility?

LCRN

[EricTAMUCC-BSN, BSN, RN]

I was asking about clotted lines.

[nursenatalie, ADN, RN]

activase, or TPA. Just instill and leave for hour then try to aspirate...ya da ya da

[LCRN]

I'm sorry,I completely misunderstood your question the night that I read it. Although when I go back and look at it now, it makes perfect sense.

We use 2 cc of alteplase in each port. We instill the med into the catheter (usually with an insulin syringe or 3 cc) and wait 1/2 hour. Then we attempt to aspirate out the alteplase and flush vigorously with heparinized saline.

This is usually effective. Sorry about the misunderstanding.

LCRN