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Occluded PICC's

I hope somebody out there can help me.  I enjoy reading this site, and always find lots of great information.  At our facility, it is "per protocol" to remove PICC's any time they become occluded, no matter what the reason for the occlusion.  It is standard just to remove the PICC and replace it with another.  Does anybody out there use Cath-Flo (or anything else depending on the cause of the occlusion) to remove debris from catheters?  What is the best practice in other facilities?  I would really like to know.  Today a patient with a double lumen PICC had one of his lumens occlude with blood because of a loose injection cap.  We were told by our facility "just use the other lumen, and don't worry about the occluded lumen.  Just don't use it."  Now, isn't this occluded lumen a medium for bacteria, clots, etc?  Seems that enzyme instillation into the PICC  is much less traumatic than PICC replacement.  Plus, is should be much less expensive.  Thanks in advance for your responses.  --  T. Jamison, CRNI

You are absolutely correct!!

You are absolutely correct!! It is better to attempt a catheter clearance procedure than to immediately replace the catheter. This is included in the national standard from INS, so it is within the common nursing scope of practice. I do believe that each nurse should have a documented competency in this procedure and that all nurses should not be allowed to do it. It should be reserved for the infusion specialists. You should assess the events leading up to the occlusion to determine if the cause is most likely to be clot, drug precipitate or mechanical. Then choose the most appropriate means to clear the lumen. See the following for more information on the many causes of occlusion:

 1.    Hadaway L. Reopen the pipeline for I.V. therapy. Nursing2005. 2005;35(8):54-63.



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

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Gwen Irwin
I wish I had my reference to

I wish I had my reference to occluded lumens being associated with bloodstream infections available. There was a study that indicated an increased risk for BSIs with occluded lumems om the ICU.

We advocate for catheter clearance at the 1st sign of a problem.

Gwen Irwin

Austin, Texas

I guess the more important

I guess the more important question is what the reason is for this kind of responses? I hope the person who gave these instructions to your clinicians are not nurses. Then it would just be a matter of educating them with the potential risks associated with an occluded catheter.

Contact the Genentech rep in your area and have them set-up an inservice or education day so that this issue could be addressed immediately.

As what Lynn had mentioned, this is included in the national standards from the INS.

Angelo M. Aguila, MSN, RN, VA-BC
Vascular Access Nurse
[email protected]

We routinely use Cathflo to
We routinely use Cathflo to clear an occluded lumen as well as lumens that do not have a blood return. It sounds a little "funny" to me that PICCs are replaced rather than cleared when occlusion occurs. That's a lot of unecessary PICC procedures, isn't it? And it is well documented in literature that an occluded lumen that is allowed to remain in place is certainly a risk for creating a BSI.
We use Cath-Flo on our
We use Cath-Flo on our occluded PICC, also. It is much easier on the patient to clear the line than to change the line. Not only is the clot a medium for bacteria, but that clot can grow and occlude the entire PICC. Cath-Flo works great. I have even been able to open a line that was completely occluded. It took sometime, but it worked.
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