Picc line occlusion

1. If the catheter is a partially occluded catheter instill the 2mg of Activase slowly over 1 min. Allow the Activase to dwell UNDISTURBED for 30 minutes.
2. If the catheter is totally occluded, clamp the occluded lumen, remove the clave, and apply stopcock. If the catheter can be identified as a Groshong PICC or PASV (Pressure Activated Safety Valve) PICC, clamping the catheter when applying the stopcock will not be necessary.
3. Attach an empty syringe to the distal port of the stopcock. Attach the 10cc syringe containing the Cathflo Activase to the medial port.
4. Turn the stopcock off to syringe with Cathflo Activase and open to empty syringe. Gently pull the plunger back to the 8cc mark. When the plunger is at the 8cc mark, turn the stopcock off to the syringe containing the Cathflo Activase.
5. Open the stopcock containing the Cathflo Activase. The medication should be pulled into the catheter. If the medication does not flow into the catheter you may apply gentle pressure to the syringe in order to instill the full 2ccs. Because of the location of the occlusion, the full 2cc may not flow in. DO NOT FORCE the Cathflo Activase. The Cathflo Activase should be infused slowly, approximately 1 minute, since this will coat the walls of the catheter and prevent denature.
NOTE: The volume infused for most catheters will be approximately 1+cc. It is acceptable if a small volume of Activase streams past the tip of the catheter.
6. Turn the stopcock off and allow the Cathflo Activase to dwell UNDISTURBED for 30 minutes.
NOTE: Syringes may be removed from the stopcock during the dwell time. When performing this procedure on a PICC line you must be sure that the catheter is secured to avoid migration. Notify the patient’s nurse to report any signs of an allergic reaction, bleeding, fever, or shortness of breath.
7. After 30 minutes of dwell time, assess catheter function by attempting to aspirate blood. If catheter function has been restored, aspirate 4-5cc.s of blood to remove Cathflo Activase and residual clot.
8. Flush the line with 10cc of normal saline (20cc if subcutaneous port), followed by the appropriate Heparin flush solution for the type of catheter. 3cc Heparin Flush 100u/cc for PICC Lines and long-term tunneled catheters (Hickman Catheters), 5cc Heparin Flush 100u/cc for subcutaneous chest and arm ports and 3cc Heparin Flush solution 10u/cc for Triple lumen catheters.
9. If no blood return is obtained after 30 minutes of dwell time reassess catheter after a total dwell time of 120 minutes. If blood is obtainable after 120 minutes, turn the stopcock off and allow the Cathflo Activase to dwell UNDISTURBED for 30 minutes.
10. If lumen remains occluded, repeat procedure.
11. If unable to obtain blood after the procedure has been repeated notify the physician.
12. Document the procedure in the appropriate documentation record.
http://www.resourcenurse.com/RN/refcenter/cath_clear

Our interventional radiology dept can sometimes 'roto-root' an occluded catheter. Or they can sometimes replace the nonfunctioning PICC by running a guidewire before removing it, then threading a new catheter into the same site.

I have run across PICCs that are occluded not by a clot, but by bunching or kinking. Sometimes simply pulling the catheter out an additional cm will relieve the occlusion. If the kink is near the insertion site, you may be able to feel it by running you finger along the vein.

our policy it almost the same, except we use retavase