Recently, an old woman in the author's department could not draw back her
blood and did not respond to her gentle pushing. The author rarely encountered
PICC in her department, which baffled us. We immediately consulted the PICC
clinic and finally cleared it up after guidance.
Items needed: one tee, two 20ml syringes, urokinase, saline.
Usage (full plugging) : use 20ml normal saline to configure 100,000 units
of urokinase (concentration: 5000 units /ml), extract 10ml of the configured
urokinase with 20ml syringe, connect the tee correctly, connect the urokinase
with the straight end, and connect an empty 20ml syringe with the side of the
tee. Turn the tee to the empty syringe end, fix the syringe with one hand, and
repeatedly draw back the syringe with the other hand to form negative pressure,
turn the tee to the other side under negative pressure, and use the same
technique to pump the pin with negative pressure, and repeat the operation.
PICC half blocking pipe processing methods: 100000 units of urokinase with
20 ml diluted saline (5000 units/ml), with 20 ml syringe 1 ml urokinase
injection intraductal, half an hour to smoke, if did not see h. smoke once every
1 hours back, until see h., returned to take more than 1 ml of blood abandon
(including urokinase) in the blood, the correct wash pipe and tube.
Common causes of PICC blockage
1. Blood coagulation blockage
Hemagglutination blockage was caused by the change of infusion pressure
improper flushing technique and insufficient flushing. When it is difficult to
feel part or all of the pumping back or push injection, it indicates clotting
blockage. Angiography can also be used to confirm the presence of thrombosis in
the catheter.
2. Mechanical plugging
Mechanical blockage was caused by the catheter disfolding and winding,
displacement to jugular vein or contralateral brachiocephalic vein, and the tip
did not reach the ideal position. Angiography can also be used to confirm the
location of the catheter.
3. Drug precipitating blockage
Due to the infusion of two or more incompatible drugs, there is
precipitation in the pipeline, and the infusion of fat milk, albumin, amino acid
and other viscous, large molecular particles will lead to liquid residue in the
pipe wall, easily causing blockage.
How to prevent and deal with it
The catheter position is correct, the scale of the catheter is recorded
every time the application is replaced, and attention is paid to aseptic
operation, positive pressure sealing and pulse flushing. Use correct flushing
fluid, volume and syringe. The mechanical blockage can be solved by changing the
position and the catheter reposition. In the case of blood coagulation blockage,
try to withdraw first (no violence, to prevent catheter rupture). If withdrawal
is not possible, use the method described in the article, but communicate with
family members in advance.