clogged PICC

Hi out there,
Husband PICC line was completely clogged today. Home nurse got doc's permission to pull the line since nothing would go in or out. (He'll get a new line in a couple of days.)

SO I finally got my hands on a genuine PICC line. I sliced it open with a razor blade and found long long thready blood clot. Seemed to be fairly continuous clot for about 25 cm. (The whole line is 36 cm.)

The line is a Bard brand in silly purple color -- silly because you can't see through it to see the clot.

Any experience with these blood clots, anyone? Hazards of same? How to prevent? How to remove?

Thanks,
Carol

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I would suggest you tell your doctor what you found in the line. I have two blood clots in my arms now due to picc lines. I would think that your doctor would want to put him on a blood thinner and look at his clotting factors INR and pro-times. Please be careful. Hope all goes well

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Will do. Thanks.

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You should have had TPA put in the line to desolve the clot....therefore avoiding a new line! TPA is a blood thinner! It gets harder & harder to get line sites!

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I have no experience at all with PICC lines - I've only had Hickmans and Ports, but I agree with Charliegirl and Krisper. Clearing the line with TPa (alteplase) should be tried before pulling the line, and a prophylactic dose of a blood thinner (i.e. coumadin) should be taken from here on out. TPa is usually pretty effective at clot busting, but sometimes has to be left in longer than the norm (don't remember what that is) and sometimes you have to play with the line after removing the TPa. By that I mean: if it is still sluggish, flush a little then pull back; flush a little then pull back. In this manner, I've been able to get more of the clot out. One time I could actually see black gunk when I pulled back. Afterward, of course, flush really well, maybe 30ccs of saline.

A central line is a foreign body, and our systems treat it as such, forming clots. It's the same way for people with artificial heart valves. I take coumadin to prevent clots; the dosage has to be adjusted for the individual, and many factors affect clotting time.

Davi

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Thanks for the replies and suggestions.

The line was completely clogged -- nothing would go in or out. Couldn't infuse TPA because nothing could go in.

Does anyone use TPA prophylactically, such as once a month?

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I've had 12 PICC lines and I'm on my second hickman, but why don't you try just using heparin maybe once per day? In the hickmans, it is recommended after each use. I don't use it at night because I instill ethanol at night and for some reason the hospital nurses never used the two at the same time, but heparin is all you should need to keep the line from clotting. Ask your doctor.

Mimi

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You should not need to use TPA regularly with a PICC and I would be too nervous to use it that often.

Mimi

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I use heprin after each use of the line. Its usally every hospital/home care policy!

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Mimi,
He does use heparin as a lock in the line every day.

He also uses ethanol flush 3x/week, followed by saline, then heparin lock.

The reason ethanol and heparin are not used together is that they form crystals immediately -- not a good thing inside a vein!

We appreciate your input.
Carol

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Thanks for the info, Carol! But the ethanol does not go in the vein! It just gets instilled in the catheter. It hurts like heck when it accidentally goes into the vein! I use the ethanol every night because I'm so immunocompromised and always get infections. I use the heparin other times during the day.

Some institutions do not use heparin routinely with the PICC lines. I've been at three that have not - they only use saline. Heparin is usually always used with the hickman, though.

Mimi

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Hi all,
Today I learned what a groshong line is! (Husband's picc is a groshong.) It means that the end of the line near the heart is not open at the very end. Instead, there are tiny openings on the sides of the line near the tip.

The directions say to flush with 20 cc saline after tpn use, being sure to use the pump-stop action. There is no mention of heparin in the directions.

Thought you'd like to know. What is a hickman, i wonder?

Carol

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A hickman is inserted in the chest, much like a port is. I have a double-port hickman so it's similar to a PICC line but it sits in my chest.

Mimi

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One of the benefits of having a PICC rather than a cuffed line or a port is that it's fairly easy for an Interventional Radiologist to change the line over a wire, I've been able to keep my current site for 2 1/2 years that way! I'm unable to use heparin (I have Heparin-Induced Thrombocytopenia) and I have a clotting disorder on top of that, so I use Cath-Flo twice a month as well as daily shots of Arixtra, a blood thinner. Someone else mentioned the importance of saving your line sites, and I agree completely. The more you can do to prolong the life of the line, the better. Perhaps flushing the line more frequently and using a posi-flo cap could help. Since I can't use heparin, I flush my line with saline every 4 hours when it's not in use. Good luck with your next line placement.

Heidi

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Heidi,
Cath-flo twice a month -- that's what I wanted to know about. If you don't mind telling me who your doc is -- mine might like to contact him/her. Have there been any problems with using this?

Carol
ccleibee@gmail.com

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Hi Carol,
I'll contact you privately with more info.
Cath-Flo, Alteplase (tPA) is the same stuff used for strokes, but the entire vial makes 2mg in a total of 2.2ml. (For comparison, the tPA dose for a stroke is 0.9mg/kg, so if you injected the entire vial of cath-flo it would be a therapeutic dose if you weighed about 5lbs.) It works by breaking down fibrin, which is my biggest problem, big hairy fibrin sheaths that stick onto the outside of the catheter and then trap actual clots in the tangled mess. I've seen what the fibrin looks like when a line's been changed out...creepy!

When I can't get a blood return, I reconstitute the cath-flo and let it dwell for 4 hours, then I draw back and discard as much as I can, and then usually that does the trick. Sometimes I have to put in a second dose and let it sit again. Every 6-8 months I end up getting the line changed out and every single one's been pretty "hairy" with fibrin, so I don't know if Cath-flo does anything for the fibrin that collects on the outside. My line is used continuously, 16hrs of PN and 8hrs of hydration. I've been mixing and administering the Cath-flo myself for a few years, but the IV nurse came to my house to do it as needed for several years before that.

One thing that did catch my eye, though, is that you mentioned that you use ethanol locks 3x a week. Ethanol breaks down the plastic that the purple power picc's are made of. I'd be really afraid that the occlusion was caused by degraded catheter lining and not fibrin, making up the clot. How long had this particular PICC been in place, and was there any trouble with being unable to get a blood return or sluggishness before this? How long does the PN infuse for, and how often are you flushing in between? (or giving other IV meds or fluids?)
Take Care,
HeidiC

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Heidi,
Thanks for the cath-flo info.

Jack's been using ethanol locks 3x/week for about 6 mo. The manufacturer of his polyurethane PICC (Bard) said that they would not support the use of ethanol in this line but would not give any specifics of why other than that it is common knowledge that alcohol degrades polyurethane.

We did as much research as we could. We and our medical, chemist, pharmacy acquaintances could NOT find anything to substantiate the idea that alcohol degrades polyurethane.

So we did it anyway. When the PICC was pulled, there clearly was blood clot in it completely for about 6 cm, and clot with center hole (tubular clot) the rest of the way up. There wasn't anything that indicated problem with the plastic.

The new PICC is silicone (same mfr) which has no stipulations re use of ethanol flush.

Take care everyone,
Carol

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