Element
Key Institutional Partners
  • Perform an audit to understand current drivers and patterns of occlusion at your facility
    • Use the CLOT tool to perform your audit to determine where occlusions are occurring (CLOT - Catheter flush, Lumens, Optimal access, Tip)
      • Remember, catheter occlusion can occur because of:
        • Mechanical problems with the catheter (kinking, pinch off)
        • Problems with the catheter caps
        • Formation of a fibrin sheath/tail within the catheter or around the tip of the catheter
        • Intraluminal thrombosis
        • Crystallization of mineral deposits (calcium, lipid, or dye) within the catheter causing physical obstruction
        • Mural or venous thrombosis around the catheter exit site
      • Strategies aimed to improve occlusion have to consider all of these possibilities
QI Team, Vascular Access Team
  • Identify which units or types of units (i.e. ICU vs non-ICU) have the highest rates of PICC-related catheter occlusion
    • Subsequent interventions in this toolkit should be focused on these patient care areas 
QI Team, Vascular Access Team
Resources/Tools
CLOT Tool (CLOT - Catheter flush, Lumens, Optimal access, Tip)
Audit form to help guide review of occlusion cases at your facility
Articles/References
Smith S, et al. Patterns and predicators of peripherally inserted central catheter occlusion:  The 3P-O Study. Journal of Vascular and Interventional Radiology 2017
  • Patient, Provider and Device Factors Associated with Catheter Occlusion
    • Patient: advanced age, elevated BMI, severe liver disease, diabetes, hemoglobin <10, ICU status
    • Provider:
      • Increased risk: left arm access, administration of cefepime/piperacillin-tazobactam/vancomycin, PICC use in the ICU setting, transfusion of PRBC (packed red blood cells)
      • Decreased risk: right arm access, verification of appropriate tip positioning, SASH method (flush with NS and lock with heparin) (SASH - Saline, Administer medication, Saline, Heparin)
    • Device Factors (strongest predictors of occlusion)- higher gauge, double lumen, triple lumen, catheter tip malposition at any point during dwell
Validation Survey
Occlusion Step 1 Validation - Review Occlusion Data
  • This document includes all of the validation questions associated with this content area to help with collaboration on responses for your hospital. Responses to the validation questions should be entered in to the linked document and recorded to monitor progress.