A patient presented to our outpatient lab last week. I was called because they could not get a blood return. The patient had a double lumen power PICC and neither line had a blood return. She stated that “they” have had problems with the line and she had a “test” done to see if the tip was in the right place. Fluroscopy showed a fibrin sheath with a 1cm flap at the tip. You could flush the catheter but could not withdraw blood. The patient stated she had one more chemo treatment and “please do whatever is needed to save my line”. Her Oncologist was called and we received orders to clear the catheter. We instilled 1mg/ml of cathflo into each lumen, waited 30min, no blood return. We left the cathflo in and rechecked the lumens again in 2 hours and no blood return. At this point you could see the concern on patients face. We repeated the dose and had the patient return in 4 hours. Unfortunately at four hours still no blood return. At this point we could of given up and pulled the line. We consulted with patients oncologist, nurses in the AIC and the patient and decided to leave the cathflo in overnight and bring her back in the am. We all wanted to save the line for the patient. Her counts were low and we were concerned about when we would be able to get another line in and she still needed weekly labs. When she came back the next day we aspirated and was able to get a blood return from both lumens! It was her birthday and the nurses in the AIC started singing happy birthday to her and the tears were flowing. Spending several hours to save her line was worth every minute. The day was a great day to be a Vascular Access Nurse!
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