Can the CLC2000®* Catheter Connector be used for administration and aspiration of blood or blood components?

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*CLC2000® is a registered trademark of ICU Medical, Inc.

Is the sterility compromised if the product gets wet?

Yes, the sterility is compromised. According to the manufacturer of Tyvek®*, the sterility of a package is maintained and guaranteed until the package is opened or damaged. If the outside of the package becomes wet it is considered damaged.

For additional information on Tyvek® visit www.tyvek.com

* Tyvek® is a registered trademark of DuPont

Can the Arrow Staple Anchoring Device be used in MRI?

Yes, the Arrow Staple Anchoring Device is made of 316 Low Carbon Vacuum Melted (LVM) stainless steel which is non-ferro-magnetic1. The 316L series stainless steels are also used to manufacture the majority of cardiovascular stents2.

The staple may induce alterations of the local magnetic field and lead to a loss of signal in the surrounding tissue3.

Abbott Ball. Stainless Steel. Physical Properties and Characteristics. Available at:
http://www.abbottball.com/products/steel.asp

Shellock FG, Morisoli S, Kanal E. MR procedures and biomedical implants, materials and devices. Radiology 1993;189:587-599

Jost C, Kumar V. Are current Cardiovascular stents MRI Safe? Available at:
See PubMed

What does Arrow recommend as a flushing protocol for central venous catheters?

Because flushing protocols differ from institution to institution and flushing requirements from patient to patient, Arrow does not advocate one set protocol. We know that our catheters maintain patency with a variety of protocols. A good resource for flushing guidelines is the Intravenous Nurses Society (INS) Standards of Practice www.INS1.org. The INS Policies and Procedures for Infusion Nursing, which can be purchased through the INS website, is another valuable resource. You can also find some general reference recommendations for central line care in the Arrow Multi-Lumen Central Venous Catheter Care, Nursing Care Guidelines (literature code ML-NG), which can be downloaded from the educational section of this site.

What is the maximum pounds per square inch (psi) that can be injected through a central line? Can we use a central line with a power injector?

Arrow has introduced a new line of multi-lumen central venous catheters with the additional indication of pressure injection. This new line of catheters gives clinicians who perform CT scans more options for scanning patients. If your patients receive an Arrow Pressure Injectable CVC or PICC, CT technicians will have the option of using that indwelling Arrow CVC without having to insert another catheter just for their scan. Arrow’s additional indication will reduce the stress on patients who up to now have had to endure another catheter insertion. Arrow now offers catheters with pressure injection indications in multi-lumen CVC and PICC configurations.

Arrow Pressure Injectable catheters are individually labeled on their extension line hubs with each lumen’s maximum flow rate. Lumens are either indicated for 4 ml/sec, 5ml/sec, or 10ml/sec. Individual lumen capabilities vary by catheter, injection pressure and ml/second, so it is important to check each catheter before considering pressure injection. Additional information on catheter capabilities can be found in the product labeling or at www.arrowintl.com/products/pressurecvc/.

The FDA clearance summary for Arrow CVC with pressure injection indications can be found at the following links:
CVC: http://www.fda.gov/cdrh/pdf7/K071538.pdf
PICC: http://www.fda.gov/cdrh/pdf6/K061289.pdf

For catheters that do not carry the Pressure Injectable indication, Arrow tests every central line lumen to 15psi. This is done on every catheter to check for interlumenal crossover and is not meant to test the maximum strength of the catheter. The non-pressure injectable catheters are not designed to withstand the high pressures of power injectors. If your current catheter is not an Arrow Pressure Injectable catheter, the maximum of 15 psi or hand injections done with a 10cc or larger syringe are indicated.

What is the length of time that a peripheral or central line can be left in a patient?

The Arrow Central Venous Catheter (CVC) is indicated to provide short-tern central venous access for the treatment of diseases or conditions requiring central venous access.

The Arrow Peripherally inserted Central Catheter (PICC) is indicated for short or long-term peripheral access to the central venous system.

Per the FDA, short-term indication is any dwell time less than 30 days and long-term indication is anything greater than 30days.

Every patient and clinical situation is different. Clinicians should evaluate the need for venous access against the patient's daily therapy regiments. Regardless of device indication, evidence based recommendations should be followed.

The Center for Disease Control (CDC) Guidelines for the Prevention of Intravascular Catheter-Related Infections¹ recommend the following regarding line "dwell" time for CVC, PICC and Hemodialysis Catheters:

• Promptly remove any intravascular catheter that is no longer essential. Category 1A recommendation
• When adherence to aseptic technique cannot be ensured (i.e. when catheters are inserted during a medical emergency), replace all catheters as soon as possible and after no longer than 48 hours. Category II recommendation
• Use clinical judgment to determine when to replace a catheter that could be a source of infection (e.g., do not routinely replace catheters in patients whose only indication of infection is fever). Do not routinely replace venous catheters in patients who are bacterimic or fungemic if the source of infection is unlikely to be the catheter. Category II recommendation
• Replace any short-term CVC if purulence is observed at the insertions site, which indicates infection. Category 1B recommendation

These recommendations can be found at the following link:
http://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf

These recommendations were summed up in the IHI 5 Million lives campaign central line bundle; suggesting a daily review of line necessity, with prompt removal of unnecessary lines.

To further review the IHI central line bundle; please follow this link:
http://www.ihi.org/NR/rdonlyres/0AD706AA-0E76-457B-A4B0-78C31A5172D8/0/CentralLinesHowtoGuide.doc

¹ O'Grady, N.P., Alexander, M., Dellinger, E.P., Gerberding, I.L., Heard, S.O., Maki, D.G., Masur, H., McConnick, R.D., Mermel, L.A., Pearson, M.L., Raad, L.L., Ramdolph, A., Weinstein, R.A., "Guidelines for the Prevention of Intravascular Catheter-Related Infections." Centers for Disease Control, August 9, 2002, Vol. 51., No. RR-10, pp. 14.

Do Arrow products contain heparin?

Arrow produces few products that contain heparin. All Arrow products that do contain heparin will have an "H" suffix (i.e. AK-15703-H) and heparin will be clearly called out on the product's lidstock. The ARROWg+ard ™ and ARROWg+ard Blue Plus® (AGB+™) catheters do not use heparin in their antimicrobial surface treatment.

Should Povidone-Iodine Ointment be used at a catheter's insertion site at the time of dressing? Why isn't the packet of Povidone-Iodine Ointment in my Arrow product anymore?

Arrow has removed Povidone-Iodine Ointment from many products and this ointment has been purposefully not included in new products. The rationale for this change is based on recommendations from the Centers for Disease Control. "Studies on the efficacy of the application of antimicrobial ointments to the insertion site at the time of catheter insertion or during routine dressing changes have yielded contradictory findings. Moreover the use of polyantibiotic ointments that are not fungicidal may significantly increase the rate of colonization of the catheter by Candida species."*

*Pearson ML, The Hospital Infection Control Practices Advisory Committee, Hospital Infection Control Practices Advisory Committee Membership List, April 1995. Guideline for prevention of intravascular device-related infections. AJIC 1996; 24:262-293. (This article is also posted on the following website: http://www.cdc.gov/ncidod/dhqp/gl_intravascular.html)

Where do I find flowrate information and priming volumes for your catheters?

Priming volume and flowrate information is conveniently located on the printed lidstock for most Arrow products.