Understanding that INS policy is to check for blood return with medication administration through VAD's....we are a home infusion company and don't have patients do this...but have been meeting resistance with some staff and checking PICC s. There is the question for PICC's re what do we do when it flushes well but there is no blood return? Is cathflo automatically given? Does the fact that the catheter walls are then exposed to this blood withdrawal create more potential for occlusion?We are especially concerned with pts on inotropes and narcotic infusions.Thanks for your thoughts
What you are describing is a partial occlusion. Where you can flush easily with NS but are unable to obtain a blood return. Sounds like a fibrin flap/sheath build up. Activase is the only thing that will dissolve fibrin. I would activase first. Usually only takes one treatment. Very infrequently 2 treatments. If you are still unable to obtain a blood return I would check for placement. A malpositioned PICC ( IJ, brachiocephalic veins) can lead to negative blood return. PICC lines left in these area have a high DVT risk. Also a partially occluded PICC can lead to catheter related blood stream infection or DVT if left untreated. So it needs to be taken care of ASAP. I would always check for a blood return before I infuse anything. I would still use the line that time but would get it taken care of ASAP.
PICCs need to be flushed well to decrease the risk of becoming occluded. If you are not concerned about fluid overload (renal or HF) then we flush with 20 to 30ml saline after blood draws or blood infusions. The more they are flushed the better they do. We rountinely flush with 10ml ns before and 20ml ns after meds/sol given. Vickey