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jenneking
BLOOD RETURN ON PICC LINES

WHAT IS YOUR POLICY ON REPLACING PICCS IF THEY ARE FLUSHING PROPERLY AND HAVE BEEN IN PLACE FOR A WHILE BUT THE UNIT IS UNABLE TO GET BLOOD RETURN FROM IT.  ARE THEY BEING REPLACED OR JUST LEFT ALONE?

Sheila
Sheila's picture
We have a policy to use tPA
We have a policy to use tPA to declot and/or dissolve fibrin sheath, which is what you are probably experiencing.  We call it persistent withdrawal occlusion, which is d/t a fibrin sheath that has formed at catheter tip and is pulled over the cath tip when you try to aspirate, therefore not getting blood return.  The tPA will dissolve it.  If you don't tPA now, you may end up with a totally clotted line, not to mention the patient may be getting stuck unnecessarily for blood draws.  It is also a potential medium for bacterial growth.

Sheila Hale, BSN, RN, CRNI, VA-BC, Austin, TX

lynncrni
You can not leave it alone
You can not leave it alone and ignore this problem. It will not go away without some intervention. Low dose tPA delivered by instillation and/or infusion will resolve the issue. There are 2 approaches - obtain a dye study through the catheter to determine the actual fluid pathway and then declot with tPA or declot with tPA first then do a dye study if the tPA does not allow a brisk blood return. The national standard of practice from INS and ONS is for a blood return before each use. To ignore this problem could result in serious negative patient outcomes that may land you in court. I don't mean to scare you but there are serious risk of extravasation injuries among other complications that can occur. Documentation of your assessment of catheter functionality will be the first thing that experts look for. A blood return is one of the components of this assessment process. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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