Central Line ocluded or sluggish?

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Specializes in ICU.

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

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Specializes in onc, M/S, hospice, nursing informatics.

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.

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Specializes in ER/ICU/Flight.

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.

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Specializes in Infection Preventionist/ Occ Health.

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.

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

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=res&cd=8&url=http%3A%2F%2Fwww.musc.edu%2Fmedcenter%2Fcvl%2Fpowerpoint%2Fpowerpoint.PPT&ei=CPqLR_uPA5TgigGD2O2FDA&usg=AFQjCNE0JEBxg2Oaamwb_mVK0aJSk-ma4Q&sig2=-QwDfI3Hqig0zVinc-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.

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Specializes in LTC/hospital, home health (VNA).

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.

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Specializes in LTC/hospital, home health (VNA).

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!

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
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.

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Specializes in ICU.

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

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

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.

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CVL's are always fun - but one advantage you do have with them are the extra ports. Unlike other lines that usually have less ports. If you have re-positioned the patient, flushed, and tried the cathflo and the line is still sluggish - naturally you also have checked your insertion site (right?) - If you are still getting blood return I would just leave it alone, and continue with flushing it 10cc saline every 8 hours; if there are meds being given, or blood draw flush with 20cc saline - make sure not to flush all the way to the end of the hub to maintain positive pressure !!! It is important to maintain positive pressure in the line, at all times. If there is no blood return, then I will consider calling your IV team for a consult on replacing the line - they can just thread one on-top of the existing line (or at least this is a possibility)... It is good practice to not use a line where you cannot get blood return from -

Plaque develops in the line, this is why it gets sluggish. Heparin is not good to use in clot busting - most of the time it is not a clot that has developed in the line, but fatty deposits. Saline is the best flush agent, and you cant increase frequency of flushes to q4h upto 20cc. Again keeping in mind to stop flushing at the 2cc or 1.5cc mark to maintain positive pressure.

I hope this helps.

Jasmine

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i see some posters saying to use heparin. what is the pt is positive for HIT?

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