![]() ![]() Fill volume varies from PICCs to ports, ranging from 0.3 to 0.5 mL. For this procedure, first determine the catheter’s fill volume. With a nonfibrinolytic agent, the goal is to increase precipitate solubility by changing the pH in the catheter lumen. Consult the pharmacist, who may recommend a fibrinolytic or nonfibrinolytic agent. ![]() If you suspect a catheter occlusion caused by precipitate, review the patient’s medical record for possible drug incompatibilities. The precipitate forms quickly, causing the line to become sluggish and hard to flush. Infusion of parenteral nutrition, lipids, phenytoin, aminophylline, or potassium gluconate with other medications promotes precipitate occlusions. bag contains multiple medications, such as potassium, incompatibility may occur in the tubing, causing precipitation. If a position change helps obtain a blood return, consult with the physician on the risks and benefits of leaving the catheter in place vs. To find out if patient positioning is affecting blood return, instruct the patient to change positions by raising and lowering the arm, or to take a deep breath or cough. ![]() Postural occlusionsĪ postural occlusion affects catheter patency or blood flow, depending on patient or catheter position. It doesn’t occur with peripherally inserted central catheters (PICCs) because they’re inserted in the arm and approach the superior vena cava from inside the vessel. It may occur with acute, tunneled, and implanted lines placed via the subclavian vein. Pinch-off syndrome is a serious complication requiring immediate attention. A more lateral catheter insertion allows the catheter to travel within the sub¬clavian vessel. As the patient raises and lowers the shoulder, repeated compression and shearing forces put pressure on the catheter. replacing it.Īnother cause of internal cathe¬ter occlusion is pinch-off syndrome, in which the catheter passes through the areolar tissue of the space outside the vessel lumen and becomes compressed between the clavicle and rib. If you suspect an internal occlusion, consult the ordering physician or licensed independent practitioner, who will weigh the risks and benefits of keeping the catheter in place vs. Causes include lodging of the catheter tip against a vessel. Internal occlusions occur inside the patient and are harder to assess. tubing and pump for obstructions and malfunctions. Check whether any clamps are activated, and look for sutures or a securement device that could be pinching the catheter too tightly. External occlusions stem from a kink or clamp in the portion of the catheter that’s outside the patient. ![]() Have a qualified clinician assess catheter-tip location from a recent X-ray, if available.Ī mechanical occlusion can be external or internal. Next, assess catheterpatency: Does the catheter flush easily, or only with difficulty? Do you see a blood return? Finally, Evaluate the patient’s medication profile for drug incompatibilities. Determine if blood return is hampered by the position of the patient’s arm or other body part (when either lying or standing). If you suspect your patient’s catheter is occluded, assess the entire infusion-delivery system for obstructions and kinks. About 40% to 50% of occlusions are nonthrombotic and result from mechanical or postural factors, medication precipitate, catheter malpositioning, or undesirable catheter-tip location. An occlusion can be thrombotic or nonthrombotic (not caused by a thrombus). Catheter occlusionsĪ catheter occlusion occurs when a blockage prevents caregivers from flushing the central line or aspirating blood. It also provides assessment, prevention, and troubleshooting tips for central lines. This article discusses potential complications-catheter occlusion, bleeding and hematoma, catheter-tip migration, catheter rupture, phlebitis and associated pain, swelling and deep vein thrombosis (DVT), infection, and embolism. To promote positive outcomes, clinicians caring for patients with central lines must monitor carefully for signs and symptoms of complications. Author Guidelines and Manuscript Submission. ![]()
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