I am curious of any insight to a commonly occuring problem at our hospital. The Bard Solo Power PICCS need a neutral valve placed to prevent the line from clotting as the Bard Solo already has a valve built into the PICC. Our hospital only carries negative pressure ClearLink valves.  This causes the two valves to fight each other causing back up of blood in to the PICC and often clotting the line. Thus, we have had numerous Bard Solo Power PICCS clot off due to nurses placing our negative pressure caps onto these PICCS. Often times we are unable to unclot the device. Furthermore, this often causes many unhappy patients/families. Has this been occuring at any of your hospitals? Any suggestions of how to prevent? Currently our hospital will not purchase any neutral caps even after numerous attempts to suggest the need. If our hospital will not purchase the correct valves, does anyone have a solution of possbile options we might have within our hospital to prevent the lines from clotting? Currently, we suggest to the patient/family if possible to bring in an appropriate valve from home (although this is not often an easy solution---as for example the other day the family stated they lived 2 hours away).

Thanks for any help!

 

Michelle 

 

I have been looking into the

I have been looking into the Cook Spectrum Picc lines but haven't been able to find much about them online.  Can you tell me what is in the kit and what your thoughts are on them up til now?

 

I am a vascular acces nurse

I am a vascular acces nurse consultant in the UK and I have been using power inj lines for 2-3 yrs now and I have been inserting around 900 last year .

been using different companies : bard, MedComp and now COOK.

if you want my opinion in any of them please contact me  

 

First of all - be sure you

First of all - be sure you know the difference between a valve, and a needleless connector.  Whether a catheter is valved or not doesn't mean it should/shouldn't have a needleless connector.

Bard recommends positive displacement connectors for the valved Solo Power PICC.  You will definitely have problems if you are using a negative displacement needleless connector.  Examples of negative displacement connectors:  ICU Medical Clave (not the Microclave which is marketed as neutral and has nil to no negative blood reflux), Alaris Smart Site (not the Smart Site Plus which is positive displacement), and Baxter ClearLink.

We have been using the Bard Solo Power PICC, and initially had an increase in catheter occlusions.  Unfortunately, we also had to implement a new needleless connector around the same time, so it was very difficult to tell what caused the occlusions. 

I've been doing a lot of education about proper care and maintenance, including flushing techniques, and our occlusion rates are much better and very low.  

We love the Solo.  It's true that I have an association with Bard, but our entire PICC team feels this way.  We have had many opportunities to try other catheters, and HAVE tried other vendors' catheters.

The home infusion clinics love them (they have NIL to NO occlusions) because they are valved, and much safer to send patient's home with.

The docs love them.  Used to be MDs didn't know and didn't care what kind of PICC they wanted us to place.  I just had an MD page me and request that we place a Solo Power PICC so they could do CVP monitoring on an ICU patient.  There were a couple of reasons why I smiled about that - one of the reasons was that I was thrilled that MDs and other providers of all kinds, seem to be catching on that Vascular Access Matters, and that there are important technical spec differences between vascular access devices.  The other reason I smiled was that it's the only kind of PICC we place now, but I didn't tell the MD that.

The ClearLink appears to be, at least by a study done by Ryder, M. et.al. and the ECRI Institute paper on Needeless Connectors, one of the better connectors in re: to bacterial transfer through it, design, etc.  But it is negative (fluid) displacement.

I think you need to pull as much data together as possible, and bring to the patient safety personnel and/or back to administration.  Include the costs related to the problems - show them the money.

Things to include at the very least: 

1.  cost of occlusion, including nursing time, supplies, delay of treatment, discharge delays.

2.  Information about the relationship between thrombi and infection.

3.  The catheter instructions for use.

4.  Information about the benefits of a valved power injectable catheter.

5.  The benefits of having a neutral displacement or positive displacement connector (including being labeled as not requiring heparin flush, though I know there is more discussion about this issue).

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RN VA-BC
Nurse Educator IV Therapy/Vascular Access Fletcher Allen Health Care

Solo PICC is a mistake and

Solo PICC is a mistake and should not be produced anymore. Just use the regular Power PICC. It has clamps so you can clamp the PICC before removing the syringe.

 We have been using the

 We have been using the BARD Power PICC since it was introduced, using saline only to flush, and have had very few occlusion problems.  We're small; average somewhere between 3,500 - 4,000 central line days per year.  So far this year we have used TPA 15 times, and in only one of those cases was it for a line that was plugged.  The rest of the uses were for persistent withdrawal occlusions. 

We use saline to flush, and a positive displacement valve.  I see Solo PICCs occasionally in patients who have been transferred from other facilities, and with our valve, we don't seem to have significant occlusion problems.  I do get more complaints that the lines are hard to flush, but I think that is because staff are not accustomed to the extra resistance that the internal valves produce.

Jerry Bartholomew RN, MSN, CRNI

VA Medical Center, Spokane, WA

Jerry Bartholomew RN, MSN, CRNI

VA Medical Center, Spokane, WA

We are having a HUGE problem

We are having a HUGE problem with occlusion/withdrawl occlusion of Solo PICCs. We have reverted back to using Groshongs unless it is extremely likely that the patient will need power injection. If the problem truly IS the type of caps that are used, then I would think Bard would supply (and/or) recommend the ones that work the best. When we contacted Bard, they had a rep come in to inservice staff on flushing techniques...things we already do. It has NOT helped.  It is very costly to use Cathflo so frequently. We use the positive pressure Smart Caps Plus. I would like to hear if anyone has come up with any solutions (including finding another Power PICC that does not have this problem.) 

There have been many

There have been many discussions about challenges with this PICC on this discussion forum. You can search this site to find many previous comments. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861