RECOMMENDED PROTOCOLS FOR USING THE FAS ENDOLUMINAL BRUSH TO RESTORE PATENCY TO PARTIALLY OCCLUDED CENTRAL VENOUS CATHETERS
Note: These protocols are for illustrative purposes.
Each Hospital Unit should review and agree criteria for implementing the use of the FAS Endoluminal Brush and adjust these protocols according to the unit’s agreed standards.
Protocol A: Non-dialysis Central Venous Catheters
A. CATHETERS WITH A REDUCED FLOW RATE OR INCREASED VENOUS PRESSURE, BUT HAVING DEMONSTRABLE FLOW IN BOTH DIRECTIONS (i.e. Blood can be aspirated through the catheter).
1. Place the patient in the supine position and create a sterile field around the hub of the catheter.
2. Wearing gloves and gown, and practising aseptic technique, flush the catheter with 20 mls sterile physiological saline solution.
3. Clamp the line, disconnect flushing syringe and swab the catheter hub.
4. Determine which FAS Endoluminal Brush is appropriate for the catheter.
5. Open the Brush pack and measure the Brush against the known length of the lumen to be brushed, adding 1.5 cms for the luer connector, and create a definitive kink in the Brush wire at the precise measurement.
N.B. Do not remove the Brush from its protective sheath.
6. Connect the FAS Endoluminal Brush to the catheter.
7. Advance the Brush into the hub and release the line clamp.
8. Continue to advance the brush to the full length of the catheter lumen in short but even steps until the kink coincides with the edge of the connector.
9. Withdraw the Brush in one single smooth movement beyond the line clamp.
10. Close the line clamp and disconnect the brush from the hub.
11. Connect a sterile 5-ml syringe to the catheter, release the line clamp and withdraw 5mls of blood.
12. Flush the catheter with 20 mls of sterile physiological saline.
13. Recommence treatment.
14. Dispose of Brush as per hospital policy.
15. Document in patient notes.
Protocol B: Non-dialysis Central Venous Catheters
B. CATHETERS WITH MINIMAL FLOW RATE AND INCREASED VENOUS PRESSURE
(Blood cannot be aspirated through the catheter).
1. Place the patient in the supine position and create a sterile field around the hub of the catheter.
2. Wearing gloves and gown, and practising aseptic technique, flush the catheter with 20 mls sterile physiological saline solution.
3. Clamp the line, disconnect flushing syringe and swab the catheter hub.
4. Insert a guidewire until the occlusion is located, kink the guidewire, withdraw and measure the distance to the occlusion.
5. Calculate the volume of the catheter dead space to the occlusion and add an equivalent volume of fibrinolytic solution. (Note: choice of fibrinolytic drug to be determined by hospital policy).
N.B. Fibrinolytic drugs may cause systemic fibrinolysis if infused into the circulation. Refer to manufacturer's instructions, indications for use, contraindications and warnings before using.
6. Close the line clamp and leave the fibrinolytic lock for 30 minutes.
7. Withdraw the solution and flush the lumen with sterile physiological saline.
8. Close the line clamp.
9. Determine which FAS Endoluminal Brush is appropriate for the catheter.
10. Open the Brush pack and measure the Brush against the known length of the lumen to be brushed, adding 1.5 cms for the luer connector, and create a definitive kink in the Brush wire at the precise measurement.
N.B. Do not remove the Brush from its protective sheath.
11. Connect the FAS Endoluminal Brush to the catheter.
12. Advance the Brush into the hub and release the line clamp.
13. Continue to advance the brush to the full length of the catheter lumen in short but even steps until the kink coincides with the edge of the connector.
14. Withdraw the Brush in one single smooth movement beyond the line clamp.
15. Close the line clamp and disconnect the brush.
16. Connect a sterile 5-ml syringe to the catheter, release the line clip and withdraw 5mls of blood.
17. Flush the catheter with 20 mls of sterile physiological saline.
18. Recommence treatment.
19. Dispose of Brush as per hospital policy.
20. Document in patient notes.
