PICC Lines

CLEARING OCCLUSIONS

If the attempts at catheter repair do not resolve an occlusion, clearing agents may

be considered. Review the risks and benefits of the procedure. Assess the continued need for the catheter, other options for vascular access, length of therapy remaining, and condition of veins.

BLOOD CLOTTING: NNPs, CNS, or Neonatal fellows may use TPA 1mg/mL. Use enough to fill the catheter lumen (approximately 0.26ml catheter volume plus volume of the three-way stopcock; 1-3 mL). Dwell time 30-60 minutes.

OTHER CLEARING AGENTS: NNPs, CNS, or Neonatal fellows may use:

1. Sodium bicarbonate 1mEq/mL. Use for precipitation of alkaline drugs (ie. phenytoin). Instill 1-3 mL into catheter and let dwell 60 minutes. May repeat once.

2. 70% Ethanol: Use for lipid occlusions. Instill 1-3 mL (maximum of 0.55mL/kg) into catheter and let dwell 1-2 hours. May repeat once.

 

PROCEDURE

  1. Supplies: 10mL syringe, 3mL syringe, sterile 3-way stopcock, sterile gloves, face mask, alcohol preps, betadine prep, may need repair kit.

  2. Swaddle baby to decrease discomfort, have assistance to immobilize extremity.

  3. Prep clear extension hub, create sterile field, don mask and sterile gloves.

  4. Remove the clave and the IV tubing from the female end of the clear tubing and attach the threeway stopcock. Attach the 3mL syringe with clearing agent to the stopcock. Unscrew the male end of the clear tubing from the blue hub. Fill the clear tubing with clearing agent and displace the IV fluids. Reattach clear tubing to the blue hub.

  5. Attach empty 10mL syringe on other port of the threeway stopcock. "Off" position will be toward the baby.

  6. Open the stopcock to the 10mL syringe and aspirate until resistance is felt. This creates negative pressure within the catheter.

  7. Turn the stopcock off to the 10mL syringe and open to the 3mL syringe. This allows the clearing agent to be drawn into the catheter.

  8. Turn the stopcock off to the catheter and allow the clearing agent to dwell in the catheter for the prescribed time.

  9. Check for blood return at the end of the prescribed dwell time. If blood return is established, withdraw a few cc of blood from the line to withdraw the clearing agent and flush with normal saline. Resume infusion of fluids or heparin lock.

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