Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Managing withdrawal occlusions

Withdrawal occlusions are defined as the ability to flush a CVAD and infuse fluids and medications but an inability to withdraw blood. If a withdrawal occlusion persists, it is expected that the individual nurse will perform only those aspects of the assessment and resolution of the withdrawal occlusion for which they have experience. It is expected that nurses seek appropriate consultation in instances where the client’s care needs surpass their ability to act independently. Nurses are expected to report the withdrawal occlusion to physician, advocate for appropriate medical interventions to determine the cause of the occlusion and for resolution of the occlusion before using the device for medication or fluid administration. Solutions such as irritants, vesicants with a pH less than 5.0 or greater than 9.0 or osmolarity greater than 500 should not be administered through a device where blood return is not obtained because if the device is malpositioned it can result in complications (e.g., infiltration and extravasation).

Critical Thinking
In some situations (e.g., palliation, access is severely limited, unblocking interventions limited or client choice), it may be necessary to analyze the risk and benefits of using a device with a withdrawal occlusion. Involvement of the other members of the health care team as well as the client in the decision is important to ensure appropriate decision-making. The client/caregivers should be assisted to make an informed consent by understanding the risk and benefits of receiving their specific infusion through a device with a withdrawal occlusion. Solutions that are non-irritating, non-vesicant and with a pH greater than 5.0 and less than 9.0, and osmolality <500, will generally result in less severe complications if infiltration occurs. Ensure safety measures are in place to reduce the risk (e.g., careful assessment for complications during the infusion).