little clamps on peripheral IVs and PICC lines. . . - page 2
by ArtsyCraftsy, BSN, RN | 7,239 Views | 17 Comments
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... Read More
- 0Nov 20, '11 by psu_213, BSN, RNWhere I used to work, we were not supposed to clamp the "new" model of PICCs being used in the hospital. An IV team nurse basically yelled at a nurse on the because she clamped a PICC. The IV nurse said that the PICC has a built in positive pressure valve and did not need the be clamped. The clamps were only there for cap changes. Then again, I had some questions about knowlege...and defnitely the professionalism) of the IV team there. It drove me nuts when they kept calling an implanted port (portacath) a 'Hickman.'
Sorry, getting off topic. Part of the reason for clamping PIVs is that blood will back up into the catheter/tubing, then it will clot, and then you will have a useless line.
- 1Nov 21, '11 by woohQuote from littleneoRNDefinitely check with your hospital educator or IV team to get the lowdown on the brand and type YOUR facility uses. Ones that "look like" other ones can be very different.When in the process you clamp (before or after removing flush syringe) depends on the brand of cap. Some are positive pressure caps and require a different process than the other ones, which I think can be neutral or negative. I do now know the ins and outs of all this, but it makes it important for you to know what brand cap you have and the specific process for that type of cap and the associated line. Check with your unit educator on this one!
This is one of those things where you should never feel stupid using your resources, because it varies too much for us average nurses to keep up while we're keeping up with everything else. Varies by brand/valves/lumen size/number of lumens/age of patient/weight of patient. Use your resources! I've got my facility's protocols for pretty much every kind line we use memorized, but I'll still check if I haven't had a PICC in a while or a port in a while and if I ever get one that was placed at a different facility, I definitely double check before assuming it's the same as what we normally do. Educators are hired to answer questions like this. And believe me, IV teams would much rather come and share info on the preventative care of lines than have to come later and try to fix the line! Make use of their expertise!h
- 0Nov 21, '11 by IVRUS"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.
- 0Nov 21, '11 by GrnTea, BSN, MSN, 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).
- 0Nov 21, '11 by RNmom24Our 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.