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Central Venous Access Device Clearance – Adult/Pediatric/Neonatal – Inpatient/Ambulatory/Emergency Department [16]

Central Venous Access Device Clearance – Adult/Pediatric/Neonatal – Inpatient/Ambulatory/Emergency Department [16] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols


Delegation Protocol Number: 16

Delegation Protocol Title: Central Venous Access Device Clearance – Adult/Pediatric/Neonatal –
Inpatient/Ambulatory/Emergency Department

Delegation Protocol Applies To:
All UW Health Patients

Target Patient Population:
Adult, pediatric, and neonatal patients with a catheter occlusion in a tunneled cuff catheter (ie.Hickman,
Groshong), PICC, dialysis, triple-lumen subclavian/femoral/jugular or implanted venous port catheter.

Delegation Protocol Champions:
Eliot Williams, MD – Department of Medicine – Hematology/Oncology
Dan Mulkerin, MD – Department of Medicine – Hematology/Oncology

Delegation Protocol Reviewers:
Anne Rose, PharmD – Pharmacy
Dawn Berndt, DNP, RN, CRNI – Manager – Infusion Center, Venous Access Team and SOS

Responsible Department:
Department of Pharmacy

Purpose Statement:
This protocol delegates authority from the patient’s primary Care or speciality care provider for
outpatients or attending physician for inpatients to Registered Nurses (RNs) and Pharmacists to place
orders for appropriate catheter clearance agents.

Who May Carry Out This Delegation Protocol:
Registered Nurses (RNs) and Pharmacists in the inpatient and outpatient setting who are trained in the
use of this delegation protocol.

Guidelines for Implementation:
1. An RN assesses the venous access device and determines it to be occluded or sluggish.
2. RN determines the cause of occlusion and identifies it as either a mechanical, thrombotic or
chemical occlusion.
3. If a thrombotic or chemical occlusion is identified the RN determines the total volume of the
catheter.
4. An RN or pharmacist places an order for the appropriate catheter clearance agent based on type of
occlusion and volume of catheter.
5. An RN instills the clearance agent into the occluded lumen(s) as directed in the UW Health Nursing
Patient Care Policy 1.56: Central Vascular Access Device Use, Maintenance and Removal (Adult and
Pediatric) and in the UW Health Central Venous Access Device Occlusion – Adult/Pediatric/Neonatal
– Inpatient Clinical Practice Guideline.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

6. If patency is restored, the RN flushes the catheter as designated in the UW Health Nursing Patient
Care Policy 1.56: Central Vascular Access Device Use, Maintenance and Removal (Adult and
Pediatric) UW Health Central Venous Access Device Occlusion – Adult/Pediatric/Neonatal – Inpatient
Clinical Practice Guideline.
7. If patency is not restored, after following all procedures in the UW Health Central Venous Access
Device Occlusion – Adult/Pediatric/Neonatal – Inpatient Clinical Practice Guideline, the RN consults
a provider for future evaluation.
References:
1. Van Miert C, Hill R, Jones L. Interventions for restoring patency of occluded central venous catheter
lumens. Cochrane Database Systematic Reviews. 2012(4):Art.No.:CD007119.
DOI:007110.001002/14651858.CD14007119.pub14651852.
Collateral Documents/Tools:
1. UW Health Nursing Patient Care Policy 1.56: Central Vascular Access Device Use, Maintenance and
Removal (Adult and Pediatric) 2016 https://uconnect.wisc.edu/policies/clinical/uwhc-
clinical/department-specific/nursing-patient-care/cardiovascular-and-infusion/156.policy Accessed
April 11, 2017.
2. UW Health Central Venous Access Device Occlusion – Adult/Pediatric/Neonatal – Inpatient Clinical
Practice Guideline. 2017 https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/cpg/medications/name-97558-en.cckm. Accessed April 11, 2017.
3. IP – Alteplase Catheter Clearance – Supplemental Order Set [3600]

Approved By:
UWHC Inpatient Anticoagulation Committee: February 2010, July 2014; *February 2017
UW Health Ambulatory Protocol Committee: March 2010; *April 2017; *May 2017
UWHC Nursing Practice Council: March 2010; *September 2014; *May 2017
UWHC Pharmacy and Therapeutics Committee: April 2010; *September 2014; *May 2017
UWHC Medical Board: May 2010; *September 2014; *May 2017
UW Health Chief Medical Office: *September 2014; *May 2017

Effective Date: May 2017

Scheduled for Review: May 2020
*Expedited approval
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org