A Peripherally Inserted Central Catheter (PICC line) is placed in a vein in the upper arm and extends to a large vein near the heart, providing long-term intravenous access. This device allows for the administration of chemotherapy, antibiotics, or nutrition. When the line resists flushing or cannot be flushed, it is experiencing an occlusion, a common issue requiring immediate attention. Swift and correct troubleshooting can often restore function and prevent delays in necessary treatment.
Initial Steps for Clearing the Line
The first action when encountering resistance is to visually inspect the external catheter system. Ensure all clamps are open and the tubing is not kinked or crimped, including under the dressing or clothing.
If the system appears clear, attempt patient repositioning to resolve a positional blockage. Ask the patient to gently change the position of their arm, shoulder, or neck, or to take a deep breath or cough. This maneuver may shift the catheter tip away from the vein wall, restoring flow.
After repositioning, attempt a gentle aspiration to draw back blood, confirming the line’s function. Follow this with a slow flush using a 10 mL or larger syringe to avoid excessive pressure. Stop immediately if any resistance is felt. Never force the flush; this pressure can rupture the catheter or dislodge a clot.
Understanding Different Types of Blockages
PICC line occlusions fall into three categories, and identifying the type helps guide intervention. A mechanical occlusion occurs when the catheter is physically blocked or compressed. This can be due to the tip resting against the vein wall, a tight suture, or “pinch-off syndrome” where the catheter is compressed between the clavicle and the first rib.
The most frequent cause is a thrombotic occlusion, resulting from a blood clot forming inside the catheter lumen or just outside the tip. This leads to fibrin buildup that can manifest as a fibrin sheath or tail. A partial thrombotic occlusion allows fluid infusion but prevents blood withdrawal, while a complete occlusion prevents both.
The third type is a non-thrombotic or chemical occlusion, which occurs when substances precipitate inside the catheter. This often happens when two incompatible medications are mixed or when the line is not flushed adequately between infusions. Lipid residue from nutritional solutions or mineral deposits can also build up, causing obstruction.
When to Seek Professional Medical Intervention
If initial repositioning and external checks fail to restore the line’s patency, contact the healthcare team immediately. Urgent reasons for a call include pain, swelling, or redness near the insertion site, or if the patient develops a fever or chills, as these can signal infection or a deep vein thrombosis. A visible change in the catheter’s external length also requires professional assessment, suggesting the tip may have migrated.
When a thrombotic occlusion is suspected, trained medical personnel may use a pharmacological approach to clear the line. This involves instilling a thrombolytic agent, such as alteplase, directly into the blocked lumen. Alteplase is a specialized medication that works by converting plasminogen into plasmin, which then dissolves the fibrin meshwork of the clot.
The professional administering the medication will allow it to “dwell” in the catheter for a set period, typically 30 minutes to two hours. They then attempt to aspirate the drug and the dissolved clot. This procedure is highly effective, with line restoration success rates often exceeding 90% after one or two doses. Using this chemical approach is significantly less invasive and costly than removing and replacing the PICC line entirely.
Avoiding complications relies on consistent and correct flushing technique. Nurses use a turbulent or pulsing flush, followed by a positive pressure locking technique, which prevents the backflow of blood into the catheter tip. This routine maintenance is the best defense against blockages, ensuring the catheter remains patent for the duration of therapy.