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Research Aims

Conclusions. Background. Research Aims. Is it Necessary to Verify Blood Return in Monthly Port Flushes?. Gloria B. Ascoli, RN, CRNI, Amy C. Brown, BSN, RN, Jessica L. Cooper, BSN, RN, Allison N. Crawford, BSN, RN, CRNI.

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Research Aims

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  1. Conclusions Background Research Aims Is it Necessary to Verify Blood Return in Monthly Port Flushes? Gloria B. Ascoli, RN, CRNI, Amy C. Brown, BSN, RN, Jessica L. Cooper, BSN, RN, Allison N. Crawford, BSN, RN, CRNI • 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 agentto establish blood return when no therapy was ordered We had four overall research aims: To determine the necessity of obtaining blood return during monthly implanted port flushes for patients with non-utilized ports To determine appropriate assessment criteria To identify causes of central venous access device (CVAD) occlusion. To state complications caused by CVAD occlusions Results Method Implications For Practice • 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 A literature search was conducted to accomplish the research aims: • Blood return must be verified prior to any therapy via an implanted port, including monthly port flushes • “Thorough assessmentof 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 • 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, recommendations for treatment Infusion Nurses Society (INS) archives and our internal policies (Sentara WaveNet) were also searched

  2. Assessment of Central Line Catheter Occlusion Chart 1

  3. Types of CVAD Occlusions Chart 2

  4. Complications Associated with Central Line Occlusions Chart 3 • Central line occlusions compromise patient care

  5. References • Andris, D., Elizabeth, K., Schulte, W., Ausman, R., & Quebbeman, E. (1994). Pinch-off syndrome: A rare etiology for central venous catheter occlusion. Journal of Parenteral and Enteral Nutrition, 531-33. • Doughtery, L. (2011). Implanted ports: Benefits, challenges, and guidance for use. British Journal of Nursing, 20 (8), S12-19. • Genetech. (2014). Catheter management education. Retrieved from http://www.cathmatters.com/education/education-cvad-care.jsp • Harpel, J. (2013). Best practices for vascular resource teams. Journal of Infusion Nursing, 36(1), 46-50. • Infusion Nursing Society. (2011). Policies and procedures for infusion nursing. • Krywda, E. (1999). Predisposing factors, prevention, and management of central venous catheter occlusions. Journal of Intravenous Nursing, 22, 11. • Kuo, Y. S., Schwartz, B., Santiago, J., & Anderson, P. S. (2005). How often should a port-a-cath be flushed? Cancer Investigation, 23, 582-5. • Kuter, D. (2004). Thrombotic complications of central venous catheters in cancer patients. The Oncologist, 9(9), 207-16. • Lawson, M. (1991). Partial occlusions of indwelling central venous catheters. Journal of Intravenous Nursing, 14(3), 127-9. • Mayo, D. (2001). Catheter-related thrombosis. Journal of Intravenous Nursing, 24(3S), S13-22. • Mehall, J., Saltzmann, D., Jackson, R., & Smith, S. (2002). Fibrin sheath enhances central venous catheter infection. Critical Care Med, 30(4), 908-11. • Reeb, H. (1998). Diagnosis of central venous access devices occlusion. Journal of Intravenous Nursing, 21 (5S), S115-121. • Rumsey, K., & Richardson, D. (1995). Management of infection and occlusion associated with vascular access devices. Seminars in Oncology Nursing, 11(3), 174-83. • Schummer, W., Schummer, C., & Schelenz, C. (2003). Case report: The malfunctioning implanted venous access device. , 12, 210-14. • Simcock, L. (2001). Managing occlusion in central venous catheters. Nursing Times, 97(21), 36. • Vescia, S., Baumgartner, A., Jacobs, V., Kiechle, M., Rody, A., Lobil, S., & Harbeck, N. (2008). Management of venous port systems in oncology: A review of current evidence. Annals of Oncology, 19(1), 9-15. • Viale, P. (2003). Complications associated with implantable vascular access devices in the patient with cancer. Journal of Infusion Nursing, 23(2), 97-102.

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