FAQ

Frequently Asked Questions Regarding Bard* Catheters & Ports

PICCs - Nursing PICCs, I.R. PICCs

QUESTION: Can Access products be used for blood draws?

ANSWER: Blood draw is an indication for central venous catheters. For PICCs, a 4 Fr or larger catheter should be used for laboratory work. Hemodialysis catheters are not recommended for blood draws. Please refer to the Instructions for Use (IFU) (IFU) for further information.

QUESTION: At what point is a catheter line considered to be a central line?

ANSWER: The catheter tip must be located at the superior vena cava or inferior vena cava to be considered a central line.

QUESTION: Can blood products be administered via a central line?

ANSWER: Yes, this is an indication for use for central venous catheters but not for Hemodialysis catheters.

QUESTION: How soon after a catheter is placed can it be used?

ANSWER: A catheter can be used as soon as placement is confirmed and the inserting physician writes an order for the catheter use.

QUESTION: Can ointments be used on Central Line insertion site on silicone Catheters?

ANSWER: It has been suggested that use can become a growth medium for infection.

QUESTION: What technique should be used for visualizing PICC lines?

ANSWER: It is important to know where the catheter was inserted, the approximate size of the catheter, the proposed route taken, and where the catheter tip is to be placed.

    Adult: A 14 x 14 cassette is used with the MR-400 screen and a Bucky tray grid. The KV is increased 5-10 over the normal shoulder technique. A normal anterior-posterior shoulder is used but with centering done more toward the sternal area. This position allows visualization of the catheter along the length of the arm, across the axillary and subclavian veins and into the superior vena cava. Visualization is further enhanced by the use of a 10-15 degrees oblique angle. In this situation it does not matter if the oblique is to the right or to the left. The result of this procedure is that the catheter tip will be shifted from the mediastinal area into the darkened lung field, thereby making tip visualization much easier. Basic settings for equipment are as follows:

    Average male: 65-75KV 100 MAS 0.5-1.0 seconds
    Average female: 54-65KV 100 MAS 0.2-0.5 seconds

    Slight adjustments may have to be made depending on the equipment being used. This will give a beginning reference point.

    Pediatric & Neonate: A rib visualization technique is used with a medium to fast screen (a fast screen will give less patient exposure, but also less detail).

QUESTION: Can catheters be resterilized if opened and not used?

ANSWER: All catheters are single-use items and resterilization is not recommended.

QUESTION: What is the minimal flow rate—keep vein open (KVO) rate—for catheters?

ANSWER: Minimal flow rates are unknown. Bard* Access Systems has no data for minimal flow rates. Intravenous Nurses' Society (INS) standard states that KVO rates are part of an actual physician IV order.

QUESTION: Is it contraindicated to have radiation therapy over the area where the catheter is inserted?

ANSWER: It is not contraindicated.

QUESTION: What kind of exercise can I do with this device?

ANSWER: See Groshong* Patient Guide

 

CVC Catheters

QUESTION: Why are ointments contraindicated with chronic dialysis/plasma pheresis tunneled catheters?

ANSWER: Ointments containing polyethylene glycol (PEG) should not be placed on the chronic polyurethane dialysis/plasma pheresis catheters. The ointment may cause the polyurethane material to become opaque, swell and crack. PEG is a common constituent of most antimicrobial ointments (e.g. Beta dine, Bactroban, Celandine, POI, and Acu-Dyne). Swelling and cracking of catheter can potentially result in significant blood loss or air embolism.

QUESTION: Can catheters be resterilized if opened and not used?

ANSWER: All catheters are single-use items and resterilization is not recommended.

QUESTION: Is it contraindicated to have radiation therapy over the area where the catheter is inserted?

ANSWER: It is not contraindicated.

QUESTION: What is the correct repair kit for a certain Broviac*, Leonard* or Hickman* catheter?

ANSWER: The appropriate information can be found in the table below:

Table from Hickman Nursing Manual – Page(s) 26 - 27

QUESTION: What is the correct repair kit for the Groshong* Central Venous Catheter (CVC)?

ANSWER: The correct repair kit is listed below in the table:

Table from Groshong CVC Nursing Manual – Page 26

Click here to enlarge table.

 

Groshong* Valved Catheters

QUESTION: Can heparin be infused through the Groshong* catheter?

ANSWER: Yes. Heparin will not harm the Groshong* catheter or the valve. However, heparin is not necessary when using the Groshong* catheter because  the catheter is flushed with normal saline to help clear the lumen of the catheter after receiving medications or having blood withdrawn for a lab test. Please refer to the Instructions for Use (IFU) for further details.

QUESTION: What is the recommended flushing procedure for the Groshong* catheter?

ANSWER: The catheter is flushed with normal saline to help clear the lumen of the catheter after receiving medications or having blood withdrawn for lab tests. A normal saline flush of 5 cc is recommended for routine flushing, 10 cc saline if blood is in the cap or catheter or if flushing past medication is completed, and 20 cc saline after blood draws or discontinuing TPN infusion. Please refer to the Instructions for Use (IFU) (IFU) for further details.

QUESTION: Can the Groshong* PICC or Groshong* CVC be clamped?

ANSWER: Yes, however, the catheter should only be clamped with a smooth edged, atraumatic clamping forceps. Do not use any device that is sharp or has teeth.

QUESTION: How does the Needless device affect the Groshong* valve?

ANSWER: Positive pressure needleless access devices do not affect the function of the Groshong* valve.  Negative pressure devices, such as the CCU Medica Product, Coeve*, or the Baxter Clearlink, product may cause the Groshong* valve to remain in the open position which could lead to blood reflux and occlusion.

QUESTION: Does clamping the extension tubing that is placed on Groshong* PICC lines affect the valve?  Will clamping the extension set cause the valve to remain open? What about if it has a needless system on it?

ANSWER: Estension leg clamps will not affect the Groshong* valve, however, clamps are not needed with the Groshong* valve. No (zero) clamps used in connection with a Groshong* PICC and a positive pressure needleless access device will have no affect on valve function as long as the clamp is closed following disconnection of the syringe.  Negative pressure needleless access devices should not be used with Bard* Access Systems PICC’s

QUESTION: Can central venous pressure (CVP) readings be done from the Groshong* or Per-Q-Cath* Plus Peripherally Inserted Central Catheters (PICCs)?

ANSWER: We have no data on this practice. This is not an intended use of the product.

QUESTION: Is it contraindicated to have radiation therapy over the area where the catheter is inserted?

ANSWER: It is not contraindicated.

QUESTION: How much of the Groshong* Central Venous Catheter (CVC) should be left outside the chest to be able to repair the catheter?

ANSWER: At least two inches from skin exit site.

QUESTION: What is the appropriate repair or connector repair for Groshong* PICC?

ANSWER: Listed below are the appropriate repair or connector repair for the Groshong* PICC:

Groshong* Peripherally Inserted Central Venous Catheters (PICCs)

French Sizes Catalog Number Replacement Connector Lumen Size Priming Volume

3 Fr. Single-Lumen (20 ga.) 7715307

7715300		 7712300 0.60 mm 0.31 ml

4 Fr. Single-Lumen (18 ga.) 7715407

7715400		 7712400 0.85 mm 0.49 ml

5 Fr. Dual-Lumen

(distal 19 ga., proximal 20 ga.)		 7725507

7725500		 7712500 (red)

7712510 (white)

7740000 (extension repair)		 0.80 mm (distal)

0.60 mm (proximal)

0.62 ml (distal)

0.48 ml (proximal)

 

Midline Catheters

QUESTION: What are contraindications for Midline catheters?

ANSWER: Midline catheters are contraindicated for final glucose concentrations above 10% and solutions with protein concentrations above 5% and patients requiring continuous infusion of vesicants.

QUESTION: Can catheters be resterilized if opened and not used?

ANSWER: All catheters are single-use items and resterilization is not recommended.

QUESTION: What is the minimal flow rate—keep vein open (KVO) rate—for catheters?

ANSWER: Minimal flow rates are unknown. Bard* Access Systems has no data for minimal flow rates. Intravenous Nurses' Society (INS) standard states that KVO rates are part of an actual physician IV order.

QUESTION: Is it contraindicated to have radiation therapy over the area where the catheter is inserted?

ANSWER: It is not contraindicated.

QUESTION: What kind of exercise can I do with this device?

ANSWER: See Groshong* Patient Guide

 

Power Injection Catheters

QUESTION: Can catheters be used in the Radiology Department with the Power Injector?

ANSWER: PowerPICC*, PowerLine* and PowerHohn* Cathers by Bard* Access Systems are approved  by the FDA for injection of contrast media up to 5 ml/second up to 300 psi.  The PowerPICC*, PowerLine* and PowerHohn* Catheters are easily distinguished from other non-indicated catheters by its distinctive purple color.

 

Catheter Maintenance

QUESTION: What syringe size is recommended for use with Bard* catheters?

ANSWER: It is recommended that a 10 cc syringe or larger be used to infuse or flush catheters. This includes pediatric and neonatal catheters. Infusion pressures should never exceed 25 psi because pressures higher than that may damage blood vessels and viscus. A two-pound weight equivalent force on the barrel of a 3 cc syringe generates pressure in excess of 25 psi. The same two-pound weight equivalent force on the barrel of a 10 cc syringe generates less then 8 psi of pressure. Please refer to the Instructions for Use (IFU) (IFU) for further details.

QUESTION: What is the recommendation for catheter dressing changes?

ANSWER: It is recommended that gauze tape dressing should be changed every 24-48 hours as necessary. Transparent Semipermeable Dressing (without gauze underneath) should be changed every seven days as necessary. Your physician will recommend dressing change frequency for dialysis catheters. Soft-Cell* has a recommended dressing change protocol. Please refer to the Instructions for Use (IFU) for further details.
The dressing should be changed ASAP if it becomes loose, wet, or crusty blood underneath to prevent serving as a possible growth medium for bacteria.

QUESTION: How often should Luer caps be changed on Bard* Access Systems catheters?

ANSWER: Every seven days and as necessary

QUESTION: How often should an implanted port be accessed and flushed?

ANSWER: The port should be accessed and flushed every four weeks when not in use. If the patient is receiving continuous infusate, then the non-coring needles should be changed every seven days and as necessary. Patients at high risk of infection may benefit from more frequent dressing changes. Please refer to the Instructions for Use (IFU) for further details.

QUESTION: What is the recommended dwell time for catheters?

ANSWER: PICCs: Peripherally Inserted Central Catheters (PICCs) are recommended for short (under 30-days) and long-term (greater than 30-days) use.  The optimal time interval for removal is unknown, however, most practitioners believe a PICC should not remain indwelling past one year.

  • Ports: For implanted ports, tunneled catheters and chronic dialysis catheters, the dwell time is indefinite if the catheter is being properly cared for and is free of problems.

  • Acute Catheters (Hohn*, etc.): Acute catheters such as Hohn* or OTG* catheters have a dwell time of two to six weeks.

  • Dialysis: Acute dialysis catheters, such as the Niagara* catheter, are intended for less than 30 days' use.

  • Midlines: Midline catheters are indicated for 3 to 4 weeks.

QUESTION: Can a thrombolytic agent be used to clear occlusions with catheters?

ANSWER: Use of a thrombolytic agent is a recommended treatment for fibrin occlusion.

QUESTION: How often do Hickman*, Broviac* and Leonard* catheters need flushing?

ANSWER: The flushing procedure varies depending on what the catheter is being used for. A doctor or nurse can clarify the intervals for when a specific catheter should be flushed. The final step in any treatment done through the catheter is a flush of some type. If the catheter has been flushed following treatment, use that time as the last flush, and schedule your next flush at the recommended interval.
See Instructions for Use (IFU) for further clarification.

QUESTION: What strength of heparin can be used on catheters?

ANSWER: 10 units/ml to 1000 units/ml has been found to be effective and is Bard*'s recommendation. Please check with your doctor for further information.

QUESTION: Are there any solutions that should not be used for cleaning the insertion site?

ANSWER: Tincture of iodine and acetone are both contraindicated. Alcohol is contraindicated for cleaning Vascath dialysis products. Use of ointments with PEG is contraindicated with polyurethane (use of these items can cause failure of these devices.)  ChloroPrep* can be used to clear all Bard* Access Systems catheters, providing the solution is allowed to dry completely prior to application of a transparent dressing.

QUESTION: Can needleless devices be utilized with catheters?

ANSWER: All catheters and winged-infusion sets are universally locking. The needleless device should Luer-Lock in place. Needless devices have their own Instructions for Use (IFU). It is Very important that you know how your device works.  If not used properly it can negate the device or valve and cause reflux in to the catheter which can lead to catheter occlusion.

QUESTION: How soon after repairing a Hickman* or Groshong* CVC can the catheter be utilized?

ANSWER: If necessary, the catheter may be used for infusion after four hours. The joint will not achieve full mechanical strength for 48 hours.  At that time, the splint may be removed.

QUESTION: How much of a Hickman*, Broviac* or Leonard* catheter should be left outside the chest so the catheter can be repaired?

ANSWER: At least 3 cm of undamaged catheter remaining beyond the skin exit site, or 3 cm remaining on the adapter leg of a multi-lumen catheter.

 

Dialysis Catheters

QUESTION: What are the flushing recommendation for the Hickman* Trifusion* Catheter? The Directions for Use are very vague.

ANSWER: The flushing recommendations will vary depending on how the line is used.

    • If the line is being used as an Apheresis catheter it is usually flushed per hospital Apheresis protocol.  Which can vary from program to program.  Most facilities will lock their catheter with priming volumes of 1,000-5,000 units of heparin. WARNING: the heparin is always drawn off before using the line with these heparin concentrations.

    • If the line is used as an open- ended CVC the line is flushed and locked with 100 units of heparinized saline q 12 hours.

    • Whatever protocol it used the line should be clearly labeled to prevent large amounts of heparin from being injected into the patient. 

 

Ports

QUESTION: Can an MRI be done with an implanted port in a patient?

ANSWER: Yes, the MRI procedure should not affect other types of catheters made by Bard* Access Systems. For further information, please refer to Instructions for Use (IFU) for ports.

QUESTION: Are catheters and winged-infusion sets for accessing implanted ports universally locking?

ANSWER: Yes. All add-on devices should have a universally locking mechanism.

QUESTION: What is the accessing and flushing recommendation for the hepatic port?

ANSWER: Access hepatic port every week. Flush with 10 cc 0.9% NaCl, followed by 5 cc 100 units/cc heparin. If medications or chemotherapy is given through port, flush port immediately after medication completion with same flush protocol.

QUESTION: How soon after catheter or port placement can an MRI procedure be done?

ANSWER: Immediately.  There is no waiting period.

QUESTION: What is the minimal length an IV cannula should be to access a CathLink* 20 Implanted Port?

ANSWER: A 20 x 1-3/4 IV cannula should be utilized.

QUESTION: Can Central Venous Pressure (CVP) readings be done from a tunneled catheter or port?

ANSWER: We have no data on this practice. This is not an intended use of the product.

 

Product Composition

QUESTION: Are Bard* Access Systems catheters latex-free?

ANSWER: All catheters are latex-free. However, gloves, tourniquets and syringe plungers may contain latex. Since September 1998 the FDA has required all manufacturer’s to put a latex warning on products containing latex. All Bard* Catheters and Ports are latex free. Any kit containing an item with latex will have an asterisk next to the item and a latex Warning on the Product

QUESTION: Are the gloves in PICC kits powder-free?

ANSWER: Yes.

QUESTION: What material is used in making Bard* Access Systems catheters?

ANSWER: Some catheters are made of silicone and some are made of polyurethane. Check the Instructions for Use (IFU) for clarification.

QUESTION: Does Bard* Access Systems have a complete latex list for its products?

ANSWER: Yes. Contact (800) 555-7422  and request a list. Leave your address and the list will be mailed to you.

QUESTION: Of what material is Chronoflex* made?

ANSWER: Polyurethane.

QUESTION: Is the glue that comes in repair kits toxic?

ANSWER: No. It is medical-grade glue that is non-toxic.

QUESTION: Does the glue in repair kits have an expiration date?

ANSWER: Yes. Check the expiration date on the kit.

 

VitaCuff* Implanted Cuff

QUESTION: Will the VitaCuff* Implanted Cuff treat catheter infection?

ANSWER: No. The VitaCuff* Implanted Cuff is a short-term barrier that may help provide protection against infection, but it will not treat an existing infection. The antimicrobial cuff is not intended to be used as a treatment for catheter-related infections. The antimicrobial cuff does not provide protection against "blood seeding" infection or infusate-related infection. It will not provide protection from bacteria for longer than one month. Please refer to the Instructions for Use (IFU) for further details.

QUESTION: If the catheter has a VitaCuff* does the physician remove it or does a trained nurse.

ANSWER: We have been told that due to tissue ingrowth around the cuff, dissection may be necessary, so usually an MD removes cuffed lines.

QUESTION: For how long is the VitaCuff* effective?

ANSWER: Four to six weeks. It is tanish in color, and is collagen material impregnated with silver ions.  You will get some tissue ingrowth with this cuff before it dissolves.

 

Education / Training

QUESTION: Does Bard* Access Systems offer PICC training classes?

ANSWER: Yes. Click here to register or Call (801) 595-5406, or (800) 443-5505, ext. 5406, for details.

You will need a special Access Code to register for the program that you can get from your local sales rep.

 Go to http://bardaccess.com/ and click on Education.

The very first selection Vascular Access Device Selection, Insertion and Management Course is our online course. The other presentation regarding PICC lines are excellent and you need no other special code to review these.

 

Educational Materials

Bard* Access Systems offers a variety of educational support materials for our catheters, implanted ports and accessories. These materials, including videotapes, demonstration kits, nursing guides, patient guides and article reprints are designed to provide clear instructions about the use of Bard* Access Systems products.

Online Courses

PICC Online Video Presentations Performance Improvement: