1/11/2024 0 Comments Power picc double lumenHave 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)? I will also have to watch rest and sleep positions to make sure that the line is not being compressed. I never thought that this might negate the effect of the positive displacement cap. I had been taught to always use the push pause flush method to clear the line and the positive pressure flush technique while disconnecting. You've given me some good tips to consider. I have not had the opportunity to work with many PICCs until now! My experience has primarily been in peds med surg and ortho outpatient nursing. In practice, if I get called because of an occluded line, 99% of the time it is a Solo Power PICC. make sure the pt is not sleeping in such a way as to put pressure on the line.remember let the PD LAD do the work of the positive displacement.many occlusions happen after a blood draw due to inproper and inadequate flushing procedures.make sure you are changing the LADs/caps/valves no more frequently than every 72 hrs but no longer than 7 days.there is a lot of literature on the technology of catheter flushing out there.will post more as I think about it. Increase flush volume to at least 10 ml NS and double it if you see blood in the line. The tip location needs to be viewed on the CXR.if the tip is up against the en often from the left side.remedial action needs to be taken b/c blood can reflux into the distal tip a bit easier not to mention any IV meds can irritate the wall of that section of the veinĥ too forceful or improper Tpa administration can damage the delicate valves.was it done correctly.Tpa should never be forced into a catheter of any kind.there are very specific techniques to administer tpa for total thrombotic occlusions Pts that increased chest or abd pressure ( ie.vomiting and coughing and intubated pts) have a higher rate of occlusion and malposition.Ĥ. heparin concentration may need to be increased to 100 units per ml.3-5 ml or the use of another anticoagulant lock can be usedģ. I know the SOLO is marketed as a "can use saline only flush" as most valved CVCs are BUT an anticoagulant as final flush (heparin being the most common) does definately decrease thrombotic occlusions. There are 2 slit valves near the hub end of the SOLO on the tails.there is a chance with the extra positve pressure flushing one could in theory be keeping one of the vavles open,thus causing reflux. In the case of a SOLO.and make sure it is a SOLO.you just flush.then disconnect.you can perform a pulsatile flush if you like but there is no evidence to prove this has any benefit with decreasing thrombotic occlusions.many IV experts now say perform a smooth and steady flush. If you are using a positive displacement LAD (leur activated device)or cap you do not need to perform positive end pressure flushing b/c as you disconnect the syringe from the cap.that type of cap performs that function for you.when you are using any open ended non-valved PICC with a clamp on the tails with a positive displacement LAD.then the proper way to do it.is to flush.disconnect your last flush syringe.then clamp.if you clamp and disconnect you have then bypassed the the positive displacement feature of the LAD. I will speak in general terms so I am not giving medical advice.as an RN when you are working with this type of line these are some things to consider.ġ. I had another Power PICC with the same problem that was pulled and replaced for this reason, constant blood reflux and frequent occlusions. The PICC line nurses at my hospital have not been able to figure out what is causing this problem. I am careful to use the positive pressure flushing technique. I have poor venous access so I need this PICC line.ĭo you all have any suggestions? Is there anything I can do to prevent the blood refluxing? It happens multiple times daily. I am on twice daily antibiotics and IVIG. This has caused several occlusions (requiring expensive cathflo treatments) and I've only had the PICC in for about 4months. The problem is, I have frequent spontaneous blood reflux that fills my lines. I use MaxPlus positive displacement caps. It is a double lumen Bard Power PICC Solo. I'm an RN and I'm having a difficult time caring for my own PICC line. Hi, I'm new to this site and I hope that I'm posting this question in the right place.
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