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Use of Cathflo in midline catheters and does anyone use stopcock method?

I'm brand new to a vascular access team at our hospital and it seems that there are many gray areas within this field, but it may be that it is just because I am new at this.

My question was is it alright to use Cathflo in a midline catheter that is unable to flush? And also I was wondering if other people use the stopcock method when using Cathflo or do you just instill it into the clogged catheter? If so could you explain why one method may be better than another.

Thank you very much for your help.

If your assessment leads you

If your assessment leads you to believe that a midline catheter has an intraluminal clot, then it would be appropriate to use a thrombolytic agent to declot. As with any catheter, you need a thorough assessment to make a good decision about what is causing the problem. Midline catheters can be associated with serious chemical phlebitis at the catheter tip because they are still in a peripheral vein. PICCs usually do not have this problem because the tip is in the SVC with much greater blood flow. 

The problem with instilling any catheter with any clearing agent (thrombolytic, alkalizing or acidifying agent, etc) would be actually getting the agent to the location of the occluding material (clot or drug precipitate). There could easily be infused fluid between this material and the catheter hub. The stopcock method allows for easy withdrawal of this fluid and maintains this negative pressure on the catheter. When you turn the stopcock to the syringe with the clearning agent, the release of the negative pressure facilitates the injection of the agent. 

Excessive force on any occluded catheter can easily lead to the occluding material being forced from the catheter lumen, rupture of the catheter wall, or both. So simply placing a syringe filled with the clearing agent on the catheter hub and injecting the agent could lead to this excessive force. If you do not use a stopcock, you can aspirate the catheter, then clamp it while you change syringes. Then release the clamp to relieve the negative pressure.


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

Dear Lynn, Thank you very

Dear Lynn,

Thank you very much for your prompt and thorough response. I appreciate all your help, and I just want to say this is the best networking you could possibly have in nursing and i think every specialty should have something like this. I will bring this information back to my team members.

Thank you!

susan parrish
Check with the manufacturer
Check with the manufacturer of the de clotting agent for guidelines and usage of the medication . I was under the impression that Cath Flo(TPA) should only be given for CENTRAL venous access not peripheral access. Mid lines are considered peripheral access; the tip is placed in a relatively large vein but does not extend into the largest Central vein. Hope this is helpful.
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