Forum topic

when you say an "occlusion"  are you referring to an occluded lumen or are you saying that had an ultrasound and they have a thrombosis?

An occlusion once properly assessed and determined not be  an external kink, catheter malposition, damage  and most likely fibrin sheath is treated with Cathflo Activase.   This is a fibrin sheath not a thrombus.

If it is a thrombus , verified by ultrasound of the extrememity then that is treated differently.  Treatment options take into consideration alot of things;   pt symptoms  extent of edema , extent of thrombus ( full occlusion, partial occlusion with blood flow around  etc...as noted on us report) ,  other vascular access needs and access options....    if the clot extends from the baslic to the axillary and or subclavian it is   typically managed with anticoagulation however many times the line is left in place and others it is removed.  It is a very individual plan of care and each doctor seems to handle it a bit differently. 

That is how it is typically managed at our facility.

I have seen  literature with an algorythm on how to manage and wether to keep the line or not when there is a diagnosed thrombus that actually includes determining if it is superficial or deep depending on the vessel selected as well as medical managment  but......not sure what its titled.   I think I have found it before on a google search and it was presented long ago in one of the conferneces I have attended. 

Sorry I couldnt produce the aritcle but wanted to atleast share how it is typically handled at our facility.

Occlusion is most commonly used to describe some form of intraluminal blockage inside the catheter. If you are asking about the vein being occluded, that is usually referred to as catheter associated vein thrombosis. The basilic vein is a deep vein where the PICC is inserted. It is a superficial vein in the forearm and through the ACF, but dives under the muscle sligthly above the ACF to become a deep vein for the remainder of its length. So you are entering a deep vein. The standard of practice is to leave the PICC in place IF the tip is correctly positioned at or near the CAJ, there is a blood return and there are no signs or symptoms of infection. There may need to be anticoagulants started. Removal of the PICC and insertion of another will only cause this problem to repeat itself at the new PICC. Please read the INS SOP on Catheter Related Thrombosis and the list of references supporting this standard. 

If you are asking about catheter lumen occlusion, see the INS SOP on CVAD Occlusion.