![]() ![]() ![]() This seems to me to be a fundamental principle of infusion therapy practice. Lynn, really, I have to ask you again with the utmost respect to clarify, you say you would shut off other infusions while declotting an occluded lumen with TPA until their compatability is determined. I'm sorry to be hung up on this point, but I can't understand why we are talking about med compatibility of TPA in an occluded lumen and concurent infusions in other lumens of this multi-lumen catheter. The previous message had emphasized the need for staggered lumens and simply do not believe that staggering brings that many benefits. So how much fluid are we pulling from the other lumen when there is this small distance between the lumens? It also seems very easy for meds with the worst incompatiblities to come into contact with each other at the catheter tip when there is this small distance. Most infusion catheter have a separation of only 0.5 cm. Also, we know from the dialysis literature that about 25% of blood is recirculated through the system when lumen exits are separated by 2 to 2.5 cm. Given the large number of nonstaggered exit lumens, I think we would have seen more clinical problems by now if staggering is necessary. I question how important staggering is if our entire body of knowledge is 1 small invitro study. This is the only study over the past 20 years and only a very few brands of all CVADs have staggered lumen exits. They were able to document precipitate occuring at the catheter tip with the nonstaggered lumens but none with the staggered lumens. They infused TPN and Dilantin through catheter with staggered lumens and nonstaggered lumens. It was an in vitro study in an anatomical model with circulating fluid to simulate osmolarity, pH, etc of blood. There has only been one (1) published study on this issue from more than 20 years ago. ![]() I was only attempting to address the issue of staggered lumen exit sites. Yes, multiple lumen catheters are for the purpose of infusing fluids that are not compatible with each other through separate lumens. Are you suggesting that we should not be infusing incompatable medications through Different lumens of a multilumen central catheter? Like Ellen said, Isn't that the whole point of a multilumen catheter? The high volume, turbulent flow of the lower SVC/ ra junction dilutes the infusates as they exit the catheter. So really we have no grounds to use 3 doses(6mg) of TPA at one time.Īlso, I'm sorry Lynn, but I'm not sure I understand what you are saying. Futhermore, they say they have no study data on any dosing greater than 4mg, meaning one dose not working to declot, and a second dose to attempt to declot. There is nothing in the "Cathflo" dosing and administration that says to treat all lumens if only one is dysfunctional. If I have a triple lumen PICC, and two lumens have a brisk blood return and flush, and one is totally occluded, then I would continue to use the functioning lumens and TPA the occluded one. First, the question was "do we stop infusions on the patent lumens while we declot the occluded lumen". ![]()
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