Connected Health

A patient came to the urgent care today with a triple lumen power PICC.  The patient was from a local skilled nursing facility and was being treated for an infection.   The nurse called and stated they were unable to get a blood return from the line.  “It infuses well, but unable to draw labs”.   When we look at best practice, we know that we should not use central lines that do not produce a blood return.   We need to take the time to trouble shoot these lines and clear the catheter if necessary.  Research has shown that occluded catheters can contribute to CR-BSI’s (catheter related blood stream infections).  When a patient has a multi lumen line, we need to care for each lumen separately.   The largest lumen is used for lab sampling,  but rotating lumen’s for infusion and lab sampling can help keep the line patent.  Be sure to flush pre and post infusion,  flush well after lab sampling and always check for a blood return before use.   If your facility uses  heparin to lock off the catheter, be sure to instill the heparin in each lumen.  When you are troubleshooting “sluggish” catheters, take off the connector and attach your pre filled saline solution and attempt to aspirate from there.  Sometimes the connectors can be the cause, if they have not been changed  correctly.  Have the patient perform the valsalva maneuver, this can help the catheter move away from the wall of the SVC.  Have the patient take a deep breath and attempt to aspirate,  you can also have the patient raise their arm above their head (if able).  We were able to get a blood return using these techniques.