what is your policy when central line won't allow blood aspiration?

[shelq56]

I was talking to a colleague about whether or not she uses a central line port for meds if she is unable to aspirate blood. I must have grown an extra head. She looked at me like I was nuts. I was taught never to administer meds through a port that won't allow blood aspiration. Is there any literature that you know of that discusses this? What does your unit policy state? Doesn't the development of a fibrinous flap on the catheter tip cause this? and shouldn't the dr be notified so that patency can be properly re-established prior to use?

Thanks for your thoughts,

Shelq56

[haji]

I asked our picc line nurse about this issue as she was placing a picc yesterday. She said she would never use a central line (picc, tlc, etc) which did not return blood. Instead she said to get an order for tpa.

Before I asked her, I asked my preceptor and got a slightly different answer- ie- check to make sure the line hasn't pulled out, measure, the tail, etc. This is consistent with what usually happens when I ask 2 people the same question...

I'm typically paranoid about safety, so I'll be calling for an order the next time I can't get a return after a saline flush.

[endorphinrush]

In my unit most of the pts are on vents and get a CXR q am. I always pull up my CXR report as well as the CXR itself. For a long time, our hospital used a contract PICC team of which I was fortunate to be a part of. we have a standing order that we can use activase to clear our ports if they do not have a blood return. I am not sure if it applies to regular CVL's though. I'll have to look. We are getting away from CVL's and using PICC's more and more though. Cheaper and less risky. Fibrin sheaths will build up if the lines are not flushed properly and regularly though. A common misconception that many nurses have is "My line is infusing so I don't need to flush it." Yea, you do. It goes a long way in helping maintain your patency.

[daniw603]

I agree with Binkey. If appropriate, and an Alteplase order can be obtained, this will help dissolve the fibrin sheath. It would be nice to have the line for labs available if needed, anyway. In most cases, if the established line has been cleared for use via x-ray, it is probably only fibrin. But things happen to lines all of the time, (I work on a Bone Marrow Transplant and Oncology critical care unit, and 100% of our patients have some type of CVC, if not 2 or 3.) Bottom line- what risks are you willing to take, what is the worst possible outcome of pt. getting or not getting the drug? what do you know about the drug- is it an irritant and what will it do if it goes somewhere besides the vascular area? Many experienced RN's have years of good luck- It's how you practice- what would you do if it were a loved one in that bed? Use your judgement. Nursing is not black and white...