Central line occlusion
Review of the Line History
(These questions are relevant in determining appropriate treatment of the occlusion.) Complete the line history before activating the algorithm.
What happened immediately before the line occluded?
· Was IV fluid infusing?
· Was the line used for medication administration?
· When the line was last accessed/flushed?
· Was the line flushed with saline and/or heparin?
· Has the line occluded in the past?
· Was the line at risk of malposition (e.g., line pulled externally, recent dressing change, change in interthoracic pressure)?
If fluids only (no medications) were running:
· Was PN infusing? If PN, check with the Clinical Nutrition Service (CNS) to be certain that the concentrations of calcium and phosphorous are compatible and not prone to precipitation. Review the entire PN formulation with the CNS to rule out other possible incompatibilities.
· If PN solution, determine if the bag was allowed to become excessively warm (i.e., placed on top of any infusion pump/under warming lights/inside an isolette).
· Were lipids also being infused? If so, were they:
(1) co-infused into the same IV line as PN or
(2) infused through a different access site?
· Was the solution a TNA solution (e.g., PN mixed with lipids in one bag) brought in from the patient's home?
If medications were given prior to occlusion:
· Which medications were given?
· Determine the concentration and length of infusion.
· How was the medication diluted for administration? (Determine diluent type & volume)
· Was a filter used?
Was there a filter in place?
Did the filter occlude? How was it treated? The Pharmacist will help to determine what caused the precipitate in the filter and correct the situation. In some instances, it may be necessary to remove a clogged filter and replace prior to resuming the infusion. Never remove a filter and infuse fluids without replacing it with a new one
Catheter Occlusion Algorithm:
Note: These guidelines were developed by a multidisciplinary group for the management of CVC occlusions. These guidelines are not intended to establish a protocol for all patients with a CVC occlusion, nor are they intended to replace a clinician’s judgment
