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2nd dose of cathflo

 Hi, Can anyone tell me if they flush with NS before instilling the second dose of cathflo or if they just administer 2nd dose after determining blood return has not been re-established? Can you also provide your source. I am having difficulty finding any references during my online search.

Thank you

Kerry McDonald RN

PICC Nurse,

Pembroke Regional Hospital

flushing between doses of cathflo

 Hi everyone, I was finally able to get onto so I was able to find some answers. Feedback is still appreciated though!

Happy New Year,

Kerry McDonald RN

K. McDonald RN, CVAA(c)


 The source for this is my

 The source for this is my professional opinion, but I would flush with saline between the 1sst and 2nd dose of tPA. My rationale is this:

1. The instillation of the first dose has already resulted in some overflow into the bloodstream, so a saline flush will not flush the entire 2 mg dose in as some has already reached the vein. 

2. The saline flush between doses will allow you to detect changes in resistance to the flush, if any.

3. Aspiration only will show only a blood return or not, but that is only part of the assessment for patency. 


Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Random VAT person
I agree with Lynn,  this is

I agree with Lynn,  this is how we do it.    


Has anyone every had a fully occluded line declot partially while instilling cathflo via single syringe technique?    I have 3 times now.  I was placing the cathflo via single syringe technique when I received a small amount of blood return.   I swirlled the syringe and injected the remainder slowly into the PICC.  I waited an hour and returned to a fully functional PICC. 

 Yes, just Monday...RN

Yes, just Monday ...

RN requested a "patency evaluation" - I found a total occlusion (patient described "pump beeping all day Saturday").  I administered the TPA via single syringe "negative pressure" and had partial clearance in 30 minutes, instilled the rest and let it dwell for the other 90 minutes to ensure full restoration.  No further problems!

I have had this before, but always wish we would get called BEFORE it's a total occlusion!  Ongoing education!!

Keely Ralston RN-BC, VA-BC, CPUI, RCIS

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