How to Declot A PICC Line Using Alteplase (rTPA)

It can be very frustrating when you go to draw blood from a PICC line and it is clotted off.  One common way to declot a PICC line is by using Alteplase (rTPA) to break up the clot.  Make sure to perform this using whatever policy is in place at your hospital.  I needed to use TPA on a PICC line recently and this is not only our hospital policy, but it seems to be the common way to instill TPA into a PICC line. 

1.  Start by grabbing your supplies:  a three-way stopcock valve, an empty 10 mL syringe, and your TPA syringe.

2.  Connect these to the PICC line as shown in the picture on the right.  

3.  Position the stopcock so it is open to the empty syringe and closed to the rTPA.  Pull back the empty syringe to create a vacuum within the PICC line tubing.

4.  With the syringe still pulled back (and the vacuum still in place), switch the stopcock valve so it is open from the rTPA syringe into the PICC line and closed off to the empty syringe.  The rTPA will be sucked into the PICC line due to the vacuum that was created. 

5.  Label the PICC line tubing as having rTPA instilled.

6.  Let rTPA sit for 30 minutes to 2 hours to break up the clot.  Aspirate 4-5 mLs blood after dwell time is completed.

5.  Always make sure to follow your hospital's policy on instilling rTPA into a PICC line.  This seems to be the common way to declot a PICC line using rTPA.