We recently had inservicing and were told that any PICC/central line without a blood return should not be used, treated as a totally occluded line and treated with tPA to get a blood return.Â I am concerned about a possible "overuse" of the tPA and wondering about the real need to treat every single lineÂ just because there is no blood return.Â How practical is it? Are there studies out there to support this fact? How many are really doing this and do you find it reduced or stopped total occlusions? And if you do treat all lines with no blood return, who does it? Do you teach all RNs or just a few designated nurses?Â In my years of practice I find many lines that have no blood return but are patent and allow the patient to complete treatments.Â I realize that chemo and vesicants fall under different rules. Thanks for your help.