The nurse is preparing to deliver an infusion of vancomycin through a client’s peripherally inserted central catheter (PICC). Shortly after the infusion begins the IV pumps beeps, indicating a blockage. How should the nurse proceed? Select all that apply.

  • start a peripheral IV in the opposite limb
  • notify the PICC nurse if unable to clear the blockage
  • use a 5 mL syringe to flush the PICC with sterile saline
  • ask the client to raise and lower the arm or cough
  • attempt to flush the line by aggressively pushing heparin to clear the blockage
  • use a 10 mL syringe to gently flush the PICC with sterile saline or tPA as ordered
start a peripheral IV in the opposite limb notify the PICC nurse if unable to clear the blockage use a 5 mL syringe to flush the PICC with sterile saline ask the client to raise and lower the arm or cough attempt to flush the line by aggressively pushing heparin to clear the blockage use a 10 mL syringe to gently flush the PICC with sterile saline or tPA as ordered
After attempting to clear the PICC following facility protocol, the nurse should notify the PICC nurse if he is unsuccessful. The catheter may be positional, which can be corrected by having the client raise and lower the arm or cough. A 10 mL syringe should be used to flush PICCs, as smaller syringes can increase pressure within the catheter and cause it to rupture or damage the blood vessels. Starting a peripheral IV in the opposite limb would not be a first-line intervention. Depending on the IV medications the client is receiving and length of expected therapy, the health care provider will determine if the PICC can be removed and a peripheral IV placed. This should only be done with a prescriber’s order. Aggressive force should never be used to try and clear a catheter, since this may cause a clot to dislodge or a fibrin tail to break off.