HMS PICC Tier II Catheter Occlusion Toolkit

To begin addressing catheter occlusion, institutions should audit current practices using the CLOT tool to identify where and why occlusions are occurring. This includes evaluating mechanical issues, catheter cap problems, and various types of thrombosis or deposits. Focus should be placed on units with the highest occlusion rates, such as ICUs, to guide targeted interventions.

To reduce catheter occlusion, institutions should prioritize single-lumen PICCs using validated tools like MAGIC, and establish clear guidelines for multi-lumen use. It’s also important to review valve and connector types, as occlusions often stem from connector issues rather than the catheter itself—neutral or anti-reflux connectors may offer lower risk. Collaborating with clinical teams and IT can help implement default order sets and ensure consistent, evidence-based device selection.

To reduce PICC-related occlusion in ICU settings, institutions should use tools like MAGIC to guide catheter selection and train staff to assess patient-specific risks before insertion. Right-arm placement is preferred when feasible, as it carries a lower occlusion risk than left-arm placement. Patient education on PICC care and activity restrictions should be provided at insertion and discharge to support safe use and minimize complications.

To minimize catheter occlusion, institutions should ensure proper PICC tip placement and documentation, incorporating tip location standards into policies. Tips positioned in the lower third of the SVC, CAJ, or right atrium are associated with lower occlusion risk. Using ECG-guided technologies or fluoroscopy for tip confirmation is preferred over X-ray or landmark techniques to enhance accuracy and safety.

To improve outcomes, institutions should educate staff on early identification and treatment of catheter occlusion, emphasizing timely intervention. Catheter salvage is the preferred approach, offering benefits like reduced therapy interruption and lower complication risks. Treatment strategies should be tailored to the occlusion type—mechanical, chemical, or thrombotic—for effective resolution.

To ensure PICC lines are used appropriately, institutions should conduct daily audits to assess device necessity, involving multidisciplinary teams during rounds. Lines unused for over 24–48 hours should prompt physician review for potential removal or de-escalation to peripheral access. PICCs placed in ICU settings should be reassessed before patient transfer, and removal plans should be documented if continued use is not justified.

If catheter occlusion rates remain high despite standard interventions, institutions should consider auditing catheter tip locations using X-rays to ensure proper placement. Early prophylaxis with tPA may help prevent occlusion, especially in catheters with poor flow or non-aspirating lumens. Due to the cost of tPA, targeting high-risk patients—such as those in the ICU or receiving TPN or chemotherapy—using the CLOT tool can help optimize its use.