A patient has no blood return from their implanted port and is scheduled to receive a doxorubicin-containing regimen. The nurse administers CathFlo per the package insert, and a second dose is needed. Neither dose results in a blood return. The nurse calls the prescriber, who consults with Interventional Radiology (IR) to evaluate the implanted port for placement and orders a port flow study. The catheter tip is correctly placed, but a fibrin tail extends off the end of the catheter. The IR physician says the port is okay to use. For how long is it okay to use the port for chemotherapy? When should the port be replaced? The nurse elects to place a peripheral IV and administers the doxorubicin dose with no problems. How should this issue be dealt with next cycle? —Name withheld on request
Fibrin overgrowth on the internal catheter is not exceptionally unusual. What must first be determined is whether it is actually a fibrin sheath or a tail (also known as a flap). A sheath, which looks like a sock covering part of the catheter including the tip, creates issues in infusing, as often solutions will infuse but may also travel back along the catheter creating issues of irritability and/or necrosis. The tail acts like a one-way valve, allowing infusion without complications or difficulty but prevents withdrawal of blood or other fluids to determine patency.
Either way, a 2-mg infusion of CathFlo (low-dose altepase) is the choice for dealing with this issue.1 Assuming that the thrombolytic was administered by the insert directions (30 minute installation) twice, the other option is to allow the CathFlo to remain in the catheter overnight. This has been used successfully and without complications.
Since today’s chemotherapy was then administered via a peripheral line, the issue is definitely what to do next cycle. If an overnight installation still fails to open the catheter to withdrawal of fluids, the surgeon should be notified for the possibility of having to replace the device before more chemotherapy is administered. —Rosemarie A. Tucci, RN, MSN, AOCN
1. Genentech Inc. CathFlo Activase prescribing information. http://www.cathflo.com. Accessed February 5, 2015.