PICC Line Occlusion

[JLevinsRNHH]

I have a VA patient who was admitted last week, upon admission he was taught to administrate his Vancomycin and to flush the line using the SASH method. It was a double lumen and he was advised to flush his Vancomycin line twice a day, once berfore and after using the antibiotic. Needless to say, the PRN nurse goes out to draw labs and both lines are clotted off. She's worked oncology before and has several methods to get the lines to flush and draw blood but none of these worked on this individual. I attempted to stick him via butterly and unable to get any return from left AC (PICC in right arm) then used a butterly to stick him in back of left hand.. I got about 4 cc of blood just enough to run the Vanco trough.. thank goodness the VA drew blood on him at office.

My problem is.. I have to go back out there tomorrow for another lab draw.. I would like to draw from the PICC but I doubt it will work anytime soon. Let me know if you nurses have any suggestions to get these lines to work.

Thanks Jodi Levins

[annaedRN, RN]

Sounds to me like an order for cath flo is needed. Better check your agencies policy on it.

[JLevinsRNHH]

If I was in a hospital setting I would agree 100%. I went out there today and changed the PICC line dressing and just decided to flush the line with saline and see if I could draw back blood... believe it or not IT DREW BACK BLOOD!!!!! So I drew three tubes, one purple, one serum and one red without serum. I advised the patient that he needed to flush BOTH lines this week, so I put an extension tubing on both ports and flushed the vanco line with saline and clamped it of. Then I flushed the blood line with saline and then with heparin and clamped the line off. We'll see if the line flushes on Wednesday or not to see if it worksl... I don't know what happened and why it worked but it did and that's all I am thankful for today. ... he' supposed to be our patient until the 9th of December and then the PICC has to be pulled on the 10th.... the thing he is pushing is that he's going on a cruise on December 10th... he smashed his ankle in a motorcycle accident in June and had his whole ankle pinned and things... then he was climbing up and down a ladder to his house and he's diabetic so he thinks he scratched his leg where he thinks he got the infection... who knows.... he likes to smoke while we are in the house... he lets the dog sit on his lap when he does his vanco... if he continues with an infection, it's his problem not mine.

[Isabelle49]

Awesome, might have been the tip was right against a wall or had a small clot that has dissolved. You lucked out!

[cathrn64]

Some PICC's like "power PICC" lines need a lot of back pressure to draw blood use a large syringe, pull back slowly, but be patient. Try repositioning the arm, turning the pt's head or having pt lay down. All of these things have worked at one time or another for me and sometime not worked on one visit, but worked the next.