[amynahmed]

Can you all let me know what you do if a central line is blocked or sluggish.
what is the assessment you go though and what interventions would you do prior to calling the Dr.?
I am looking to see if we have a common practice for this or does everyone do a different thing?

P.S. Would appreciate if you can send me a protocol checklist if possible

Thanks
Amyna

[mom4josh]

Flush with saline, then heparin if not effective. After that, if you're still having trouble, you can try a product called Activase. You inject that and let it sit for a while (follow instructions carefully). Usually takes care of the problem.

[RNREMT-P]

Yeah, flush with NS, then Heparin. If it won't draw or flush then we give a drug called Alteplase (Cathflo). It's a thrombolytic and it should resolve the problem.
As far as a checklist, we will usually page the PICC team and let them handle the Alteplase as they use it far more often.

[BSNDec06]

We flush with saline and attempt blood return. If none can be achieved, we usually call in another nurse (one more senior/experienced). If there is still no blood return on a particular lumen, we let the resident know and they order tPA for us. We do not have a CVL team on off-hours.

If we are having problems with a port, we usually go through the same steps except that we attempt to reaccess before we try tPA.

[BBFRN]

Retaplase (or some other enzyme) and the 3 way stopcock method works pretty well- unless the PICC is clogged with TPN.

http://www.google.com/url?sa=t&ct=re...qig0zVinc-hkVQ

Here's a very good Powerpoint tutorial on how to do it. See slides 32-41. See the whole thing for other info regarding PICCs & other lines.

[dhyser96]

Sometimes -as well as flushing with some extra saline - just having the patient reposition (whole body as well as arm with the PICC) while trying to get the blood return. I always try that quite a few times before the tPa.

[dhyser96]

Sometimes -as well as flushing with some extra saline - just having the patient reposition (whole body as well as arm with the PICC) while trying to get the blood return. I always try that quite a few times before the tPa. It's worked quite a few times for me! Sorry for the repeat post!

[BBFRN]

Originally Posted by dhyser96

Sometimes -as well as flushing with some extra saline - just having the patient reposition (whole body as well as arm with the PICC) while trying to get the blood return. I always try that quite a few times before the tPa. It's worked quite a few times for me! Sorry for the repeat post!

Good point- I've had success with straightening the arm out and abducted, and having the pt turn his/her head away to the opposite side. Always try that first before tPa.

[amynahmed]

Thanks everyone who responded to my concern. Now I am fully aware of central line occlusion. But what do you do when it's sluggish? I am still debatable about sluggish Central lines. Please help me out here.

Thanks
Amyna Ahmed

[BBFRN]

Repositioning, flushing, or tPa are all things you can do to fix a sluggish PICC. tPa isn't going to help if the line is sluggish because of TPN, though.

You can also try changing the dressing and repositioning the tubing under it as well, in case it's kinked.