Purpose:
 To restore patency to a catheter with a blood or chemical occlusion   Supplies:  (1)   Sterile injection cap or needleless system(1)   Thrombolytic agent
(3) Â Â 10 cc syringe with attached 1 in. needle or needleless adapter
(1) Â Â 10 cc sterile normal saline filled syringe with attached 1 in needle or needleless adapter
q       Isopropyl alcohol wipes
(1) Stopcock – 3 way
ÂProcedure:
Â1. Â Â Â Â Â Notify physician immediately of suspected catheter occlusion and type of occlusion (i.e. blood, chemical precipitate)
Â2. Â Â Â Â Â Obtain treatment orders for thrombolytic agent. Â Cautions contained in medication package insert should be observed
Â3. Â Â Â Â Â Review patient chart for allergies, medical history & condition, lab coagulation studies, and contraindications to procedure
Â4. Â Â Â Â Â Explain procedure to patient and obtain patient informed consent
Â5. Â Â Â Â Â Wash hands and glove and any personal protective equipment needed
Â6. Â Â Â Â Â Use aseptic technique and observe blood and body fluid precautions and universal precautions
Â7. Â Â Â Â Â Remove injection cap, attach an empty 10-cc syringe and attempt to aspirate. Â If aspiration is successful withdraw clots and flush. Â If aspiration is unsuccessful proceed forward
Â8. Â Â Â Â Â Document procedure in patients medical record upon completion of one of the two methods
Â
Â
Syringe Method Declotting | Stopcock Method Declotting |
Draw up thrombolytic agent into a 10 cc syringe to equal the internal volume of the catheter (volume may be reduced if catheter length has been altered) | Attach stopcock to cannula hub. Â Turn stopcock to off position. Â Unclamp catheter. |
Aseptically attach thrombolytic filled syringe to the catheter hub. Â Slowly and gently inject the thrombolytic agent using a push-pull motion to achieve maximum mixing. Â To avoid catheter rupture do not force entire amount into catheter if strong resistance is felt | Connect empty syringe to one port of stopcock. Â Connect syringe filled with thrombolytic agent to second part of stopcock. Â |
Leave 10-cc syringe attached to catheter. Â Do not attempt to aspirate for 30 - 60 minutes | Open stopcock port connected to empty syringe. Â Gently aspirate empty syringe to 8-9 cc, then close port, creating negative pressure |
After 30 – 60 minutes attempt to aspirate 5 ml of blood to assure removal of all drug and clots | Open stopcock port connected to syringe filled with thrombolytic agent.  Gently inject thrombolytic agent into catheter.  Do not force. |
Remove blood-filled syringe and replace it with a 10-cc syringe filled with normal saline.  Flush catheter to verify patency | Close stopcock to catheter.  Secure device to patient and label “Do not use† Allow agent to dwell in catheter for 30 – 60 minutes |
Attach sterile, saline-filled injection cap or needleless device | Open stopcock to catheter aspirate 3-5 cc of blood and discard. Â Flush with 10 ml of 0.9% sterile sodium chloride. Attach sterile, saline-filled injection cap or needleless device |
If unable to aspirate, repeat procedure, Â If unsuccessful notify physician | If unable to aspirate, repeat procedure, Â If unsuccessful notify physician |
This may help to clear the catheter of calcium phosphate or other drug precipitates. Â Sodium bicarbonate may also be used for precipitates that are soluble in a basic solution