Purpose. The purpose of this trial was to confirm safety and efficacy with thrombolytic use on complete and partially occluded central catheters using alteplase for the home care population. This trial attempts to provide additional evidence for the safe and effective use of a thrombolytic agent for catheter clearance, specifically with home care patients. Method. Patients were eligible for inclusion if (1) blood could not be withdrawn for partial occlusion or (2) blood could not be withdrawn and inability to flush presented with complete occlusion. Through an established Protocol, using the negative-pressure technique, nurses administered alteplase, 1mg/1 cc concentration, to home care patients who met inclusion criteria. Instillations were repeated at 20-minute intervals for up to three repetitions, if needed, with the third instillation remaining overnight. Results. Instillation of alteplase was successful in clearing catheter thrombotic occlusions in 66. 7% of patients studied in this outpatient population without thrombolytic events or drug related adverse effects. Conclusions. The authors confirm that catheter occlusions can be safely resolved in the alternate care/home care setting using established negative-pressure protocols. Although overnight dwell was used successfully and unsuccessfully in this trial without adverse effects, the small sample size does not Provide adequate definitive conclusions.
A prospective, sequential, controlled trial was conducted to evaluate the clinical and cost consequences of securing arterial catheters with a precision-engineered securement device compared with tape and transparent membrane dressing (TMD). Tape and TMD securement resulted in an unscheduled catheter restart rate of 25%; the study device resulted in an unscheduled catheter restart rate of 12.8%. The difference was highly significant (P < .001).
When new products are introduced into the medical environment, the necessary education is best handled as a collaborative effort between the manufacturer and the institution purchasing the product. This education has been dramatically impacted by safety legislation and the advent of the safety-engineered devices that are now required as health care facilities work to protect health care workers from sharps injury and blood/body fluid exposure. The authors address this changing environment, as well as responsibilities for both the manufacturer and the facility when new products are introduced.
With the growing demand for home infusion therapy and the limitations being placed on the home care agencies, it is becoming increasing important for the home care nurse to have a clear method for addressing the needs of these patients. Education of the nurses, the patient, and caregiver(s) and carefully listening to determine their needs, fears, strengths, and weaknesses are critical. In addition, adaptation of the plan of care and teaching techniques to best meet the learners' needs, without compromising the quality of the care provided, are important to help ensure the safe and successful provision of home infusion therapy.