little clamps on peripheral IVs and PICC lines. . .

[ArtsyCraftsy]

Hi everyone,

I'm a new nurse and am puzzled about those tiny little clamps that are on the peripheral IVs (you know, the ones you slide back & forth to clamp and unclamp) and the ones that are on PICC lines and Central lines (the ones you squeeze to clamp and unclamp)

I guess this is a dumb question, but do they ALWAYS need to be closed when something is not actually going in? If so, why? WHAT ARE THEY REALLY FOR?

I had noticed in my clinicals that in some hospitals the peripheral IVs didn't have these clamps, so I'm wondering what is the purpose of these clamps?

Should you open them before or after you attach your syringe or IV line? Does it matter?

And when do you close the clamp after a flush? Do you close it before all the liquid gets in?

I couldn't find any info on the internet about this, and I feel so ignorant and clueless.

If you can, please provide info about the peripheral IV access devices and also PICC lines and Central lines.

Would appreciate any info! Thanks!

[AJPV]

Thanks for the info on PICCs! I'll be starting a new job soon, so I'll be sure to pay attention/ask questions about this topic.

[IVRUS, BSN, RN]

"It drove me nuts when they kept calling an implanted port (portacath) a 'Hickman.'

Yes, I would really question the expertise of an IV nurse in this case. Hickman catheters are named after the MD who invented the tunnelling procedure, Dr. R. Hickman. Therefore, implanted ports are NOT Hickman Catheters!

But for the OP, all IV catheter which DO NOT have a integral valve in them, (unlike the Groshong and the Solo Power PICC, PASV IV catheters) have a clamp on them so that when you make injection cap or tubing changes, you can have the line clamped and not worry about a blood back up or air emboli (AE). So, yes, when not in use keep the clamp SHUT. If the leur-lock injection cap is not screwed on well to the IV catheter, the cap can fall off, and then you should be concerned with AE and Blood loss. A valved catheter needs a well fitting cap on it to prevent bacteria from entering the line, but one shouldn't be concerned with the other findings so much as it is rare that a valve malfunctions.

Also, how you flush is dependant on the type of injection cap you use. Positive Displacement caps (Not positive pressure) are flushed and then before you clamp, one must remove the syringe to allow the forward movement of your final locking solution to move out of the IV catheter, thus preventing a reflux of blood.

This is not the same way use flush a negative or neutral cap.

Do check with your IV educators in your facility, or come back here and I'll help if I can.

[nurseprnRN, BSN, RN]

"i always clamp them off so that air does not get into the line, especially for central lines (what if those little blue caps were to come off? air embolus!) - but i'm talking about the clamps on the lines themselves, not on the iv tubing."

once again, an air embolus in even a central line would have to be pretty big to do any harm (30-50cc is often quoted for adult-sized person), because it cannot go to the brain to cause a stroke absent a very specific (and uncommon) set of intracardiac malformation circumstances. there was recently a thread on this here.

however, with a central line it's easier for air to enter if the line is open to air, because the patient's inspiratory effort makes a negative pressure (suction) in the chest and can pull air down the catheter. clamp the line or turn a stopcock off to the outside if you have to open the line to air. you can ask the patient to cough, but that's not always reliable. if you're pulling the line (or a chest tube), have the patient take a deep breath and cough, and yank it out quickly as he does so. if your patient is on a ventilator, time your yank to inspiration (positive pressure in the chest).

[RNmom24]

Our PICC lines don't have clamps and they are saline flush only. Our central lines clamp and we are supposed to clamp them AFTER flushing the line with 10mL saline and 1mL heparin. Our peripheral extension sets have clamps and I sometimes clamp them off, especially if the person is having blood backing up into the tube. It can clot off in some people.

So, I would see what your equipment requires you to do, it seems to change and vary between institutions.

[ArtsyCraftsy]

Thanks so much to all who replied! Very helpful info and I see I need to find out more about the specific equipment my hospital uses. Thanks again to all!

[That Guy, BSN, RN, EMT-B]

We do not ever clamp our lines. The only time you clamp them is if you are replacing the T connector on them. Otherwise they stay unclamped.