The infusion was completed without any complications, and a brisk blood return was again noted in the patent lumen at completion. Furthermore, an examination of Danielle’s chart showed that several instillations of alteplase had been used in the past without benefit.ĭanielle’s nurse contacted her hospital’s clinical nurse specialist, who agreed with the physician that the patent lumen would be safe to use for the rituximab infusion. However, Danielle stated that she needed to get her infusion started because she had to be home to pick up her children from school. Ideally, both lumens would be functioning. However, studies have not been conducted to evaluate the risk of using a patent lumen in a double-lumen catheter where the opposing lumen does not draw. Although the incidence is unknown, extravasation and infiltration from a fibrin sheath is a possibility. In Danielle’s case, the nurse was concerned that one lumen of the nondrawing catheter may have a fibrin sheath. The risks are different for nonvesicants, where patient harm is more closely related to infiltrating significant volumes of fluid. In addition to being able to easily flush a device, the presence of a brisk blood return has been recommended by both the Infusion Nurses Society and ONS.Įxtravasation, with potentially serious sequelae, is typically associated with the administration of vesicant chemotherapy.
Danielle comments that the “outside lumen hasn’t drawn well since it was placed a few months ago, and that the other nurses have been using the inside lumen.” The nurse accesses the inside lumen and is able to get a good blood return.Įstablishing patency prior to IV therapy is one of the basic foundations of parenteral medication administration.
Then I would flush the line with a 10mL NS flush and draw 10mL of blood for my waste. After accessing the lateral septum, the nurse is unable to get a blood return, even though saline flushes easily. If it were me and I had a patient with a triple lumen PICC (never seen more than a double lumen PICC) and I had something infusing into each lumen, I would pause one of the infusions and disconnect the line. Danielle has a double-lumen implanted port and is scheduled to receive rituximab for lymphoma.
0 kommentar(er)
