HI Lynn-
At our organization we use Mosby's Skills for our polices and procedures. Last spring they eliminated the 3 way stop cock method for completely occluded central lines. We have been in touch with the Alteplase company and have reached out to several other organizations for what their practice is when they experience a completely occluded line. I have recevied a variety of answers and most organization report that they do not have a policy regarding the best practice for occluded catheters. We have researched EBP articles for best practice and are not coming up any good research. Do you have any recommnedations or advice for restoring patency of a completely occluded catheter where you are not able to instill alteplase in any way?
Sue Monson, BSN, RN, OCN
They probably changed this because stopcocks are definitely related to increased infection risk but this is when left on the catheter. If you put the stopcock on the hub, do the procedure and remove it, the stopcock should not increase the risk of infection other than the manipulation of the hub. The reason for the stopcock is to create a negative pressure inside the lumen. You can do this by aspirating then clamping the catheter before disconnecting the syringe. The issue is aspirating the fluid between the hub and the occlusion so that the tPA can reach the occlusion. Stopcocks should not be left on the catheter. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861