Cant get a blood return from jugular central venus line?

I couldn't get a blood return from the jugular the other night from the distal port. We have a protocol for altepese for picc lines that we can't get a blood return.......but it doesn't say what to do for this. the other two ports had great blood return.
I bet it had a fibrin clot on the end of the distal lumen... At my hospital we would TPA just that lumen...

I have problems like this with CVLs all the time. If I can't get a blood return but that lumen flushes easily, I would first just heparinize it and let it sit for several hours. If I still couldn't get a blood return, I would ask for an order for TPA.

Also see if it's as simple as positioning, occasionally we'll see central lines that have one lumen sitting up on the SVC wall and don't draw back but flush fine, more often when they are dry. You can try having the patient turn their head and draw back, or have them lay down to increase venous return to the SVC and see if that helps. If not, then it prob is a fibrin sock/clot.