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Jeff Hanks
Managing the clearing of lines after PICC service hours
For those of you that have PICC service but do not provide it 24/7, how are managing the occasional need for clearing of occlusions?  My team is not here all the time and my current policy is that I prohibit the use of alteplase by staff nurses.  It rarely occurs because we are proactive in clearing lines before they are 100% clotted, but one of the directors asked me to look at having the ED staff complete this.  The ED director does not want to touch it.  What they (ED) do now is start a PIV (as long as it is nonvesicant) just so the patient can continue with therapy and then send them in for line clearing during regular hours.    Am I correct in holding on to this responsibility so tightly or should I be training the ED staff?  I ask you opinion's.
My opinion is that this

My opinion is that this should remain in the hands of the most skillful and knowledgeable staff - your team. I do not think that most ED nurses would have the time or be motivated to learn and properly use this technique. No other nurse will have the same knowledge and skill with vascular access as an infusion nurse. However, there must be a way to meet patient needs in a timely manner. If the patient can not or will not be stuck for a PIV or if the therapy can not be infused through a PIV, then one of your nurses should be on call to come in and do this procedure. I don't think you can hold on to a procedure if you are willing to provide total coverage so that patient needs are met. Just my opinion based on many years of experience in and total support for a 24/7 full service infusion therapy team. 

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

Karen Ratz,RN St. Lukes

Karen Ratz,RN St. Lukes Hospital, Cedar Rapids,IA

In our absence(we don't have someone in house 24/7) , our Oncology staff provides this service.

Karen Ratz,RN, VA-BC Unity Point St. Lukes Hospital, Cedar Rapids,IA

Donna Fritz
We also trained some of our
We also trained some of our more experienced infusion center and oncology staff to perform this function, in part, so they could address the needs of their own patients in a timely manner.  They were called on weekends at times.  But it is always difficult to get them off of their own unit and on to someone else's.  My experience with ED staff is that they don't have alot of experience with troubleshooting ports and tunneled caths.
I say give power to the

I say give power to the people.  I teach for Cathflo, but I was also that night shift nurse that needed that blood specimen in the middle of the night, or I needed that line for a dopamine drip all of a sudden.

Admittedly, technique may not be as good as good as someone who does it all the time, but if a few key people can be trained properly(i.e. charge nurses, and willing staff) then this would expedite things and minimize delays in therapy. 

If you say you're pretty proactive in clearing lines before they are 100% occluded, then this would mean that most occurences at night would be partial occlusions, and these are easily fixed and do not need much skill to do correctly.

Ideally, you would want to have standing orders or post procedure orders that include Cathflo as PRN so they won't hesitate in using it in the middle of the night and not have to call the MD for something like this.  Then you would want to have some extensive education to get this to fly.

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