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.