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Declot central lines

I work at a hospital without an IV team. There are 3 of us trained to place PICC lines and declot central lines. My question is for hospital without IV teams - who declots in your facility? Is it every RN or just a select few.

Thanks in advance!

rivka livni
Like you, we do not have an

Like you, we do not have an IV team, one RN places PICC Monday through Friday(excluding Holidays) 0700-1700. The PICC RN is the only one decloting lines.

I must say though that we have only about 1-3 declots per month, and at any given time we have at least 35-50 PICC inhouse and quite a few outpatients PICC visits in our IV infusion clinic.

The intensive teaching of flushing the lines and when IV infusion is going we do not allow the staff to have a rate less then 30cc/hr, has helped keep the line patent more then anything else. We do only NS flushes, and all our PICCs are Power PICC that allows nurses to flush with some moderate force.

I did teach one Charge RN on our SNF unit to declot their lines (they have a lot of PICCs), and so far it has worked, no BSI related to Cathflo.

If a catheter occludes on the weekend, they wait until Monday.

Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

It truely depends on your definition of a clotted line

Complete occlusion which means no aspiration and no fluid delivery or partial occlusion which means no blood return or sluggish flow

partial is more commonly found and less often treated

Occlusions should be treated 24/7 as they affect patient flow, med delivery, lab draws, therapies such as nutritional support, pain control, monitoring in the ICU

I am in favor of training the entire hospital RN staff.  It is just a med like any other med.  RN's deliver meds  The patient does not respond to Monday-Friday service on days last I heard


Kathy Kokotis

Bard Access Systems

rivka livni
To Kathy Kokotis: It is NOT

To Kathy Kokotis: It is NOT like any other medication, since it "lifts" all bio-material off the inner lumen, including Bactereia, it does carry a higher incidence of Bacteremia.(read the prospect) Not all RNs read the prospects of medications. After installing the Cathflo, if the RN flushs the lumen to see if it works, and does not withdraw first, it does put the patient at a higher risk of CRBI, especially if the catheter has had a long dwell time, used for TPN, the patient is nuetropenic etc.

I personally saw two cases where the 85 days old catheter was flushed after Cathflo, without withdrawing first and the patients became Bacteremic within 48 hrs. Since then we decided to go with specially trained RN only to declot lines. The risk of Bacteremia, is not worth it.

Then add the risk of

Then add the risk of catheter rupture when a primary care nurse is far too aggressive with her instillation technique. I agree that this is a specialty task and should not be in the hands of all nurses. 


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

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Anita La Roche
In order to declot catheters

In order to declot catheters RN must first attend  PICC care and maintenance class, Sepcial Cathflo in-service and perform return demonstration to be classified as Competent to perform catheter declotting.



Antioch, California

Anita La Roche, R.N.

To add to the other

To add to the other comments, this is where a safe practice should be written, so that those facilities without a dedicated IV team 24/7 to do trobleshooting such as declotting central lines, they can train their  supervisors on each shift to do the procedure. This is not a daily occurence in all patients that has lines, so therefore any  staff nurse can NOT just perform this confidently and safely without bursting/ rupturing that patient's life line. Some patients cannot wait for next Monday to get their lines opened up. That's why they have these lines for reason.

I agree for more inserviices is needed, and a clearly written policy and procedures.

We have had Cathflo

We have had Cathflo inservices for our Special Care (SICU,MICU,CCU,etc) nurses.  Once completing the inservice, they are checked off for competency.  The PICC team manages all the occluded lines outside the special care areas.


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This procedure would require

This procedure would require competency validation. Your facility would need to have a lot of declotting procedures to get all staff through a competency validation process in a timely manner. If you had that many, I would work on improving your outcomes and decreasing the total number. If you don't have that many, I think it will be a logistical nightnare to get every nurse's competency documented. Even if you could get them all through a program and you have a low number of procedures, they will not be able to maintain this competency. I believe this is a technical procedure that requires the advanced skill and knowledge of an infusion nurse. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Nadine Nakazawa
Nadine Nakazawa's picture
Declot by staff nurses

 We do NOT have an IV team and never have.  We've had to deal with this issue (declotting) for many years.  It has been a staff nurse procedure for over 15+ years (urokinase before 1998, streptokinase from 1998-2000, alteplase from 2000 to present).   The reality is that the bulk of the declotting has been done for years by the nurses in the oncology and BMT units for their patients, by the outpatient infusion (oncology and non-oncology)  and by the "Crisis Nurses" in the other units.  Over the years, we have done inservicing and competencies on the various units, and over time more and more nurses "get it."  I also teach a Basic PICC /VAD Nursing Management course through Stanford's CE Center twice a year for the past 14+ years, and many of the staff nurses have taken that course.  I cover all the steps and rationale for assessment, prevention and management of "dysfunctional catheters."  I've also taught vascular access focused topics to the various nursing units over the years, and that captures the majority of the nurses of that unit all at once.  The reality is that not all staff nurses feel comfortable declotting and will defer to someone who is more comfortable or experienced.  But over time, we have nurses on many if not most of the units who are now "competent" to declot.  We emphasize proper flushing before and after accessing and 20 mls NS flush after lab draws.  The selection of a proper needleless connector is also important.  We do have a competency attached to the Declotting Procedure.  With 2100 PICCs placed a year, there is NO way we (the Vascular Access Team) could possibly assess and declot.  We are swamped with just doing insertions.  We consider, and have considered it to be for many years, a nursing assessment and procedure.  It takes a "plan" and a systemic approach.  The VA Team places all our PICCs with the tips in the lower third of the SVC near the juncture with the R atrium, so that at the time of placement, we have proper functioning of the PICC.  

Nadine Nakazawa, RN, BS, VA-BC

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