Research Aims Method Background Results Conclusions • Sixteen articles met inclusion criteria •Fifteen articles were selected for review •Articles provided evidence supporting establishing blood return during monthly port flush •Search of WaveNet revealed an established policy, providing an assessment tool and subsequent interventions in the setting of an We had four overall research aims: 1. To determine the necessity of obtaining blood return during monthly implanted port flushes for patients with non-utilized ports 2. To determine appropriate assessment criteria 3. To identify causes of central venous access device (CVAD) occlusion. 4. To state complications caused by CVAD occlusions Implications For Practice Gloria B. Ascoli, RN, CRNI, Amy C. Brown, BSN, RN, Jessica L. Cooper, BSN, RN, Allison N. Crawford, BSN, RN, CRNI Is it Necessary to Verify Blood Return in Monthly Port Flushes? Data Bases: Google Scholar, CINHAL, and PubMed Keywords: Monthly flush, blood return, fibrin sheath, implanted port, withdrawal occlusion Inclusion Criteria: Adult population, implanted port, malfunctioning port, recommendation s for treatment • It is necessary to establish blood return during a routine monthly port flush 1 • Assessment includes multiple pathways for determining causes of occlusion (see chart 1) 2 • Major causes of occlusion include mechanical, non- thrombotic, and thrombotic(see chart 2) 3 • Major complications include infection, infiltration, etc. (see chart 3) 4 A literature search was conducted to accomplish the research aims: Infusion Nurses Society (INS) archives and our internal policies (Sentara WaveNet) were also searched •Nurses in our outpatient infusion center see patients with implanted ports requiring routine monthly flushes for maintenance only •Nurses were often encountering partial withdrawal occlusions from implanted ports during routine monthly port flushes •Partial withdrawal occlusion – the ability to flush easily but inability to aspirate blood •Nurses questioned the necessity of a thrombolytic agent to establish blood return when no therapy was ordered • Blood return must be verified prior to any therapy via an implanted port, including monthly port flushes •“Thorough assessment of the patient and the CVAD for the potential cause of an occlusion will be performed, and the appropriate intervention will be performed to restore catheter patency (INS, 96)” • Nurses should be educated about the importance of the ability to aspirate blood from a CVAD prior to use
Transcript
Research Aims
Method
Background
Results
Conclusions
• Sixteen articles met inclusion criteria
•Fifteen articles were selected for review
•Articles provided evidence supporting establishing blood return during monthly port flush
•Search of WaveNet revealed an established policy, providing an assessment tool and subsequent interventions in the setting of an occluded CVAD
We had four overall research aims:
1. To determine the necessity of obtaining blood return during monthly implanted port flushes for patients with non-utilized ports
2. To determine appropriate assessment criteria
3. To identify causes of central venous access device (CVAD) occlusion.
4. To state complications caused by CVAD occlusions
Implications For Practice
Gloria B. Ascoli, RN, CRNI, Amy C. Brown, BSN, RN, Jessica L. Cooper, BSN, RN, Allison N. Crawford, BSN, RN, CRNI
Is it Necessary to Verify Blood Return in Monthly Port Flushes?
Inclusion Criteria:Adult population, implanted port, malfunctioning port, recommendations for treatment
•It is necessary to establish blood return during a routine monthly port flush
1
•Assessment includes multiple pathways for determining causes of occlusion (see chart 1)
2•Major
causes of occlusion include mechanical, non-thrombotic, and thrombotic(see chart 2)
3
•Major complications include infection, infiltration, etc. (see chart 3)
4
A literature search was conducted to accomplish the research aims:
Infusion Nurses Society (INS) archives and our internal policies (Sentara WaveNet) were
also searched
•Nurses in our outpatient infusion center see patients with implanted ports requiring routine monthly flushes for maintenance only
•Nurses were often encountering partial withdrawal occlusions from implanted ports during routine monthly port flushes
•Partial withdrawal occlusion – the ability to flush easily but inability to aspirate blood
•Nurses questioned the necessity of a thrombolytic agent to establish blood return when no therapy was ordered
• Blood return must be verified prior to any therapy via an implanted port, including monthly port flushes
•“Thorough assessment of the patient and the CVAD for the potential cause of an occlusion will be performed, and the appropriate intervention will be performed to restore catheter patency (INS, 96)”
• Nurses should be educated about the importance of the ability to aspirate blood from a CVAD prior to use
Complete (unable to flush or
aspirate blood)
Contact Interventional
Radiology to assess
Partial (negative blood aspiration)
Assess for external mechanical causes
Assess for non thrombotic causes
Assess for thrombotic causes
Per protocol, instill catheter clearance
agent
Positive blood return, proceed
with catheter use
Complete occlusion (unable
to flush or aspirate blood)
Partial occlusion (negative blood
aspiration)
Assessment of Central Line Catheter OcclusionChart 1
Types of CVAD OcclusionsChart 2
Types of central venous catheter occlusion
Mechanical•External:•Clamped or kinked IV tubing•Tight suture at catheter exit site•Non-coring needle dislodgement and misplacement
•Internal:•Improper catheter tip placement•Catheter kinking or compression
Non-thrombotic•Drug precipitates•Crystallization of total parenteral nutrition admixtures
Thrombotic•Deposits of fibrin and blood components•Intraluminal•Fibrin Sheath•Fibrin Tail•Mural Thrombus•Irritation from catheter rubbing against the intima of the vessel wall
•Portal Reservoir Occlusion58% Throm-botic
42% non throm-botic
Risk for Infection
•Formation of fibrin deposits and biofilm is a natural response that can start upon catheter placement•Attracts, encloses, and protects bacteria and other microorganisms•Microorganisms can be released into the bloodstream causing central line associated infection
Infiltration or Extravasation
• Infiltration causes pain, discoloration, and swelling•Extravasation is more severe, and can result in pain, edema, and tissue necrosis•
Thrombosis
•A thrombus between the catheter and the cell wall can lead to complete blockage of the vein•This can be a life-threatening condition with potential complications, such as pulmonary embolism
Delay in treatment
•Canceled or delayed procedures• Increased length of stay (LOS)• Interruption in administration of medications and solutions, especially vesicants
Central line occlusions compromise patient care
Complications Associated with Central Line Occlusions
Chart 3
References
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Simcock, L. (2001). Managing occlusion in central venous catheters. Nursing Times, 97(21), 36.
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evidence. Annals of Oncology, 19(1), 9-15.
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