Consider auditing catheter tip location if occlusion rates remain high
Element
Key Institutional Partners
  • Perform X-Rays to examine catheter tip
Providers, IR, Quality Department
Articles/References
​Lee J, et al. Displacement of a power-injectable PICC following computed tomography pulmonary angiogram. Radiology Case Report 2017
  • Case report and literature review related to PICC displacement or migration after contrast injection for radiologic study recommending review of catheter tip position following CT
Morden P, et al. The role of saline flush injection rate in displacement of CT-injectable peripherally inserted central catheter tip during power injection of contrast material. American Journal of Roentgenology 2014
  • Laboratory testing indicates PICC tip migration following contrast media injection for CT is likely often unrecognized and underreported. Higher rates of saline flush administration associated with contrast injection may be the primary cause of catheter tip displacement
Lambeth L, et al. Peripherally inserted central catheter tip malposition caused by power contrast medium injection. Journal of Vascular and Interventional Radiology  2012
  • Report of patients who experienced PICC catheter movement following injection of contrast for radiologic studies
Early prevention of occlusion via tPA prophylaxis
Element
Key Institutional Partners
  • If occlusion rates do not decrease with the steps above, early and aggressive prophylaxis of occlusion with tPA products is recommended
    • Catheter with sluggish, slow or poor flow -> tPA prophylaxis
    • Catheter lumen not aspirating but flushing well -> tPA prophylaxis
    • If tPA is used as a prophylaxis measure, contact the coordinating center
Providers, Quality Department, Administration
  • Because tPA is expensive, it may be best to target prophylaxis of occlusion in patients at high risk of this event (ICU, TPN or chemotherapy patients) – use the CLOT tool to determine where events are occurring to consider this possibility (CLOT - Catheter flush, Lumens, Optimal access, Tip)
Providers, Quality Department, Administration
Articles/References
​Goossens, GA.  Flushing and locking of venous catheters:  Available evidence and evidence deficit. Nursing Research and Practice 2015
  • A review of intravenous catheter flushing and locking describing techniques, sufficient volumes, and necessity. High risk associated with common flushing agents requires investigation of alternatives