If there is more than one lumen in a PICC or Central line and one lumen is occluded and cannot be cleared but the other lumen is open and functioning should the line be pulled or is it okay to use the open port?
there is no literature I can find to answer your questions but I hesitate to have a blocked lumen as the risk of infection may possibly increase
There is no evidence to support the risk only the fact that thrombus and infection may be interrelated
You would however have to asess the patient and determine if this is their only VAD option.
I would want to know why it cannot be cleared and I am assuming you are referring to the clearnace procedure with a thrombolytic drug. The occluison could be something other than a thrombolytic occlusion. You would need to assess the history of how well the catheter has performed up to this point. Was this occlusion a sudden event or was it a slowly decreasing flow rate over time? Was it correctly flushed with saline between each and every drug? Is it being used for lipid infusion, especially a total nutritent admixture? For a subclavian insertion site, is there a difference in blood return when the arm is repositioned? All of these answers will help the infusion/VA expert to determin if this is a drup precipitate, lipid sludge, or a mechanical occlusion such as pinch-off syndrome. You should also obtain a dye study in radiology to determine fluid flow pathway. All of this should be done before sacrificing the CVAD. If this is a temporary CVAD in an inpatient, you should assess the need for the catheter and remove it if no longer needed. For a long-term CVAD, this approach to assessment and management is needed before removal. Catheter lumen occlusion is not always a thrombus problem. Lynn
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