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the thumb and forefinger of the nondominant hand. Insert the Huber needle
slowly through the skin directly into the septum of the circular reservoir until the
back of the reservoir is reached. Unclamp and gently withdraw to assess for the
presence of blood, then slowly inject saline. Watch for local infiltration, which
may occur if the needle is not properly placed. If local infiltration occurs, remove
the Huber needle. Blood drawing is accomplished through extension tubing after
clearing the line of dead space volume. If blood is being drawn, 3 to 5 mL must
be drawn and discarded before collecting the amount necessary for testing. Place
a dressing over the site and secure the catheter with chevron-shaped silk tape.
Medications or intravenous fluids may be attached. Normal saline flushes should
be administered between medications. Flush with 5 mL of heparinized solution
when medication or fluid administration is complete or after blood drawing is
accomplished. Remove the Huber needle. Place a dressing or adhesive bandage
over the site once the needle has been removed.
Peripherally Inserted Central Catheters
To access a PICC, first scrub the access port per institutional protocol, using a
twisting, frictional scrub for a minimum of 15 seconds and then allow for
complete drying. Using sterile technique, access the port of the lumen with a 10mL syringe filled with normal saline. Aspirate to confirm blood return. After
confirming patency, flush using a pulsatile technique until all flush solution has
been administered, thus clearing the line of blood, medication, and/or intravenous
fluid. Maintain pressure at the end of the flush to prevent the reflux of blood into
the catheter; repeat for each lumen of the catheter. Follow the manufacturer’s
instructions for the clamping procedure at the end of the flush.
Nonpatent Catheters—Use of Fibrinolytics
When tunneled CVCs or implantable ports are not readily accessed, the most
common reason is presence of a clot. The clinician should consider use of a
fibrinolytic to assist in clot dissolution as long as it is not contraindicated.
Alteplase (2 mg/2 mL)
For patients weighing less than 30 kg, alteplase can be instilled in an amount
equal to the catheter priming volume plus 10%, not to exceed 2 mL (2 mg) and
should be allowed to dwell within the catheter lumen for 120 minutes. For

patients weighing more than 30 kg, a 2-mg dose should be instilled and allowed
to dwell within the catheter lumen for 120 minutes. Then, attempt to withdraw
blood with a 5- to 10-mL syringe.