Need heparin flush for PICC if...?

[biretta]

Hi. I am currently orienting as a new grad on a medical unit. Could someone please clarify this as I have been told conflicting information: For a PICC that requires a heparin flush, i.e. would need to be hep locked if not infusing, if it happens to be used for intermittent infusions, e.g. antibiotics say like 2xs per shift a few hours apart, do I need to hep lock it? Isn't the heparin really only required if the PICC sat without infusing for an entire shift? Thanks, I need to get to the bottom of this without overstepping my preceptor.

[GrumpyRN63, ADN, RN]

That's how we do it. It gets heparin if not in use period. If intermittently in use, meds, atbx's, etc, we just use saline flushes.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I use heparin anytime I remove tubing from the PICC. Orders change, pt stay longer in radiology etc. Your hospital should have a policy for this. IMHO if your giving meds every two hours I'd hang a NS at TKO and piggy back the med to save time and the frequent hep flushes,.again I'm sure your hospital has a policy about this!

[iluvivt, BSN, RN]

The PICC needs to be flushed immediately after intermittent use (locked off). Your hospital will have a policy on the flush type and frequency that they want. Here is a sample of ours. Flush q 12 hours and prn with 10 ml normal saline followed by 50 units of Heparin (10 units per ml). Increase the NS to 20 ml after a blood draw. You must flush with something after use and this will usually be saline . There are a few medications that are incompatible with NS,but only a handful.and usually these will need a D5W flush,then you can use the NS. Please check the facilities CVC protocol so you can follow it.

[donewit08]

I am glad this came up. I was told in my clinical rotations that you always flush a PICC line with heparin when you have used it for whatever (antiobiotics, etc). Then we were also told that when you get to the real world(your first job), that it depends on what your facility chooses to do. You need to find out what your facility has choosen to do. If you believe it to be wrong, then start checking out research that has been done on when a PICC line should be flushed with heparin. See what the majority of the research has proven. If what you believe is found out to be the majority of the research, bring it up with other nurses and the hospital commitee. Remember we are suppose to be advocates for the patients!

[classicdame, MSN, EdD]

The Standards of Practice by the Infusion Nurses Society states that NS or other flush solutions are ok as long as your policy states it and the mfg of the PICC line recommends it. OVERUSE of heparin can cause Heparin-induced Thrombocytopenia. The minimum volume of the flush solution should be equal to at least twice the volume of the catheter and add-on device but NS should not exceed 30 ml (adults) every 24 hours. Pedi and nursery pts. should not get preserved NS for flushing PICC lines.

Frequency is not mentioned in the Standards, except that it should be done at established intervals to ensure patency. SOOOOO, I would use NS if you are giving a med and NS at other times and document that it was done at least every 8 hours. Be sure to flush all the ports.

[biretta]

Thanks everyone. I'll try looking up the hospital's policy.

[iluvivt, BSN, RN]

The 30 ml NS limit on adults only applies to NS with the preservative benzyl alcohol,if preservative free there is no limit.

[helpnhands]

We flush with heparin once a shift unless the line has iv fluids going.

[classicdame, MSN, EdD]

I made a mistake. I meant NS with meds and heparin at other times. The idea is to flush frequently and do all ports. Skipping ports seems to be a problem in our facility.