Which is included in managing CVAD catheter occlusion?

• A. Flush with NS using a 10 mL syringe and avoid forcing
• B. Immediately remove catheter
• C. Administer thrombolytic agents without evaluation
• D. Increase IV fluid rate

Answer: (A)

When a CVAD is occluded, the immediate goal is to restore patency with a gentle, controlled flush rather than applying force. Using normal saline with a 10 mL syringe is preferred because a larger syringe reduces the pressure you generate when you push, making the flush gentler and less likely to damage the catheter or push debris further into the lumen. A push-pause technique helps dislodge a small clot or precipitate without forcing it through the catheter.

If this gentle flush doesn’t restore patency, clinicians would evaluate and may escalate to other interventions per protocol, but you don’t rush to remove the catheter or administer thrombolytics without proper assessment and orders. Increasing IV fluids won’t address an intraluminal blockage, and giving thrombolytics without evaluation can be unsafe.

So, the best initial step in managing the occlusion is flushing with saline using a 10 mL syringe and avoiding forceful pushing to protect the catheter and establish patency.