The nurse attempts to flush a client's subclavian vein central venous access device with normal saline using a 10-mL syringe, but meets resistance, is unable to aspirate blood, and suspects an occlusion. What should the nurse do next? A)Flush and lock with heparinized saline flush B)Flush with normal saline using a 5-mL syringe C)Notify the health care provider D)Reposition the client

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11ecbb05_cb74_e93a_b433_cb14b35ca7f7_MD0009_00 Catheter occlusion is the most common complication of central venous access devices. Kinked tubing, catheter malposition, medication precipitate, or thrombus can occlude the lumen, preventing the ability to flush or aspirate blood. The nurse should first assess for mechanical, nonthrombotic problems by: Repositioning the client (eg, head, arm) as the catheter tip may be resting against a vessel wall (Option D) Assessing IV tubing for clamps, kinks, and precipitate The nurse should then attempt to flush the device again. If the occlusion remains, the nurse should not flush against resistance as applying force may damage the catheter or dislodge a thrombus. Instead, the nurse should contact the health care provider (HCP), who may prescribe medication (ie, alteplase) to dissolve a thrombus or fibrin sheath. (Option A) Most needleless connector manufacturers recommend flushing with normal saline. Some facilities may use heparinized saline flushes; the nurse should follow HCP prescriptions and institution guidelines. Heparin flushes should be at the lowest acceptable dose (eg, 10 units/mL) to prevent heparin-induced thrombocytopenia. (Option B) Flushing with a syringe smaller than 10 mL causes increased intraluminal pressure and may damage the catheter. (Option C) The nurse should rule out a mechanical problem before notifying the HCP. Educational objective: Occlusion of a central venous access device can be related to mechanical, medication precipitate, or thrombotic causes. The nurse should first attempt to remove the occlusion by eliminating a possible mechanical obstruction (eg, reposition client to adjust catheter tip location) before notifying the health care provider.

The Nurse Attempts to Flush a Client's Subclavian Vein Central