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PICC occlusions

Wanted to find out from everyone what are your interventions (if any) for PICC occlusions prior to instilling CathFlo.  The current literature says to determine whether the occlusion is mechanical first...our current guidelines are to change the PICC dressing and pull the PICC back up to 1 cm to see if this takes care of the occlusion.  Are we off base with this guideline?  Thanks, Barb

How about changing the

How about changing the needleless cap as a number one.  It is often the cap

Check from the pump or IV line to the catheter for kinks or blocks to flow

I would do all of that before changing a dressing or pulling back the catheter

Kathy Kokotis

Bard Access Systems

In my opinion, I would not

In my opinion, I would not immediately change a pts dressing if there appears to be an occlusion as you are just letting in an entrance for bacteria. If a PICC or any other central line appears to be occluded, what we first do is check for any mechanical occlusion...without taking off the dressing, are there any noticable kinks in the tubing, is the machine working properly, is the clamp unclamped, raise the pts arm, have the pt cough, ect. as the catheter may be malpositioned, look at the last medications given, could there have been some crytalization that had just occured, switch caps. If all of these are ruled out, we then order Cathflo (2mg for adult or 110% of the internal lumen volume of the catheter for pts under 30kg) and install as directed. If this does not work after 2 doses, we then contact the physican and  confirm placement with a CXR .

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