Members are discussing various strategies and solutions for dealing with occluded PICCs. Suggestions include using a smaller volume syringe, changing caps, using thrombolytics like TPA, and ensuring proper technique for infusions and blood draws. There is also mention of the importance of assessing for mechanical, thrombotic, and non-thrombotic causes of occlusions and the need for prompt treatment to prevent complications.
I'm curious as to why this would happen. This morning I was supposed to draw blood from a PICC line for labs. The patient let me know that the nurses the last few days have not gotten a return, so lab has been drawing his blood the last few days. Sure enough, neither port, medication nor blood, gave me a return, but flushed well and fluids ran perfectly well into the line.
I went to draw blood on my next pt with a PICC. I got no return from the red port, but got a good return from the other one.
I feel dumb asking. What is going on here? Other than in scenario #1, the PICC not being in correct placement, yikes, what are the possibilities for this?
Is it simply the beginning of clogging and thus will, for the time being, flush thin fluids but not thick fluids like blood? On both patients, I did have to push hard to flush.
However, an access RN once told me that some types of leur locks make it feel like you are meeting with a lot of resistance, but that it's normal and perfectly patent.
This is a very interesting thread for me because my unit is having a heck of a time with one PICC.
Pt has ABI, Lupus Plus is being treated for TB. 3 different IV a/b. Basically gets an IV a/b q 2- 4 hours.really needs a PICC.
Those suckers just keep on blocking. After the 2nd blockage we started running IV TKVO between a/b and the PICC still blocks! Twice it has blocked while we are drawing blood! I have never had a PICC block while fluids are infusing or while drawing blood.
Any ideas?! I am wondering if it is connected to,her lupus
My money is that you are having an issue with mechanical occlusion. Could be where the catheter is terminating, could be that it is looped or kinked within the body, or could be that it is kinking in the tissue of the arm.
A radiograph of the arm and chest might be interesting.
However, an access RN once told me that some types of leur locks make it feel like you are meeting with a lot of resistance, but that it's normal and perfectly patent.
Confused
Certain types of PICCs and some needleless access devices will have valves in them that will require a certain threshold of either pressure or vacuum to overcome the valve. It's not much though.
My money is that you are having an issue with mechanical occlusion. Could be where the catheter is terminating, could be that it is looped or kinked within the body, or could be that it is kinking in the tissue of the arm.
A radiograph of the arm and chest might be interesting.
PICC has been changed at least 4 times due to blockage. And another 2 times because pt pulled it out.
Very frustrating. Her veins are becoming badly scarred from repeated use when the PICC is out.
Try drawing the blood with a smaller volume syringe, creates less suction.
Not true and not EBP. You should use only a 10 ml syringe or larger unless you are using a special large bore 5ml syringe to avoid damaging the line.
OP were the PICCs ever de-clotted before they were replaced? If they were I agree this patient is probably hyper coagulable and may need either Heparin or Citrate as the final instillate rather than saline. I've had this happen to a handful of my patients. One of my port patients has an oncologist that orders Alteplase instead of Heparin for her port. Not really something I'd recommend.
This has probably been mentioned already (I did not read all of this thread), but sometimes just lifting the patient's arm up above their head when doing a blood draw helps.
You have a flappy clot at the end of the line. It needs a thrombolytic like TPA to clear it. The patient is at increase risk of infection because bacteria can cling to the clot. This is not trivial and can cause severe septicemia/sepsis. A PICC without blood return should not be used in non-emergent situations.
CountryMomma, ASN, RN
589 Posts
Hypercoagulation ? What's the labs look like? Need Asa or heparin treatment?