PICC Ports that won't Flush

  1. 0
    I am looking for suggestions on what to do when a PICC port won't flush. I am paranoid about dislodging a clot or breaking the catheter, causing an embolus. What do you do when you attempt to flush with saline and the port just doesn't flush?

    Do you apply pressure and try to force the flush? Do you use heparin? Do you use alteplase? Call vascular access? What is your opinion
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  4. 10 Comments so far...

  5. 2
    I have the patient move their head/neck/arm in case the line is positional. If that doesn't work than I ask for an alteplase order, per hospital policy.
    tcvnurse and melmarie23 like this.
  6. 0
    We have a standing order for tPA 2mg/2ml for PICCs/CVLs that won't flush. You kind of push it gently to instill it, then push more in a few minutes, and work it in like so. We leave it in for 30 minutes then aspirate it back. Sounds like you might be talking about a home care setting though.
  7. 0
    The dwell time can actually be extended up to 2 hours and then it can be repeated once. Once you get a blood return you want to make sure you withdraw enough to make sure the TPA does not go into their circulation. I also recently read you can do sodium bicarb for some clots (medication related), however, I have not yet done that.
  8. 1
    PICC ports don't flush because people aren't flushing them regularly or they are not flushing adequately after drawing blood from them. (though I can understand why this happens from time to time when people get extremely busy, but I always flush ports that do not have fluids running through them when I do my assessment, if possible (nothing critical going on)). However, there are times when the line is just positional as a PP said. Turn their head to the opposite side of the PICC, and try raising their arm, as well. Our hospital has the same policy as the above PP, but refer to your policy where you work. There really shouldn't be a need for activase if the ports are being flushed regularly.
    *4!#6 likes this.
  9. 0
    Do as everyone else said... try moving their arm, turning their head, etc. to see if it's positional. We sometimes would take the cap off and try to flush a little heparin into it that way, then change the cap and recheck in an hour or so if it could be flushed with saline. If it truly wouldn't flush and needed tPA- it was hospital policy that the IV team had to instill it.
  10. 0
    Replace cap with a new one. Sometimes a clot forms in the cap because a nurse did not flush and clamp with positive pressure. Ask your dept mgr to get a copy of the Infusion Nurse Society standards. Very helpful. Welcome to INS1 - Infusion Nurses Society
  11. 2
    First try gentle aspiration.... gently aspirate, then try to flush, gently aspirate and then try to flush... 9 times out of 10, I'll pull back a small fibrin strand and then I can discard that syringe and have another syringe with 5 cc NSS and flush through... IF gently aspiration does NOT work, then get an order for Cathflo, 2mg/2ml to declot.
    I usually ask for a MD's order f, to include the drug and "may repeat x1"

    99.9 % of the time, I get it open by direct connection and aspiration.
    turnforthenurseRN and Esme12 like this.
  12. 0
    Good suggestions from PP's. Never force flush, though!
  13. 0
    first try gentle aspiration.... gently aspirate, then try to flush, gently aspirate and then try to flush... 9 times out of 10, i'll pull back a small fibrin strand and then i can discard that syringe and have another syringe with 5 cc nss and flush through... if gently aspiration does not work, then get an order for cathflo, 2mg/2ml to declot.
    i usually ask for a md's order f, to include the drug and "may repeat x1"

    99.9 % of the time, i get it open by direct connection and aspiration.

    i was going to say that i have my patient in every position possible, straightening the arm, moving the arm up, down, anything to try to gentle aspirate, i have them sit, stand, lay and move the arm and try gentle aspiration, i straighten out the catheter. if nothing works our home health agency uses cathflo 2mg/ml. we insert the cathflo, wait 2 hours, and then aspirate the cathflo (5-10 cc blood) works well. i was told by the cathflo representative that came in and gave a presentation a few years ago that even if the cathflo is pushed in and not aspirated, it's not that dangerous. she said it was like taking 2 325mg aspirins. i have only had one patient that i could get nothing to work on, and i had to send her to the er to have the picc replaced as they could not get it to work either.


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