PICC line Q

MunoRN, RN · Feb 20, 2011

The y-tubing extender shouldn't cause any problems in terms of excessive pressure, as long as the combined pressure and flow of everything going in to a single lumen isn't beyond that lumen's capacity, and the lumen is patent. (A Power PICC lumen is rated for up to 5ml/sec - or 300ml/minute - and up to 300 psi).

nurse2033, MSN, RN · Feb 20, 2011

Sounds OK to me, just watch IV compatibility of meds.

JemJ · Feb 21, 2011

Thanks! The Reason I was asking is that another nurse implied that this was the reason the PICC line no longer gave blood. The medications were compatible, and the total rates were much lower than 300cc/min - it may have been something like 200cc/hour total. Are Power PICCs what most hospitals are usually using now? We don't see them too often, and for some reason, when we do, they tend to not give blood after the frist few days, even if we are flushing them every 4 hours. (The PICC line team doesn't like us too much . . .) Just trying to learn as much as I can from someone who knows :)

MunoRN, RN · Feb 21, 2011

PICC's can have a 'flap' that forms on the end which can act like a one way valve, causing them to infuse easily but often when you aspirate then the 'flap' closes over the tip. Power PICC's still need to be flushed with heparin to help prevent this, and if a fibrin sheath still forms then it needs TPA. Even SOLO PICC's still need heparin for this reason, although the manufacturer claims it usually only needs saline, the SOLO valve only helps prevent in-line occlusion but does nothing to prevent a fibrin sheath.

A y-adapter won't necessarily cause an occlusion, although if you replace a neutral or positive pressure cap with a y-adapter that doesn't have these caps on it, you may be more likely to have a in-line occlusion due to blood being pulled back into the lumen when you remove the syringe.

iluvivt, BSN, RN · Feb 24, 2011

Yes Ok to add any small extension set to a PICC line. Yes continue to flush your PICCs per your protocol. What you have described is a PWO (persistent withdrawal occlusion) in that you can instill through the PICC but not easily or at all withdraw blood. The current standard of care is to treat with Tpa (Cath-flo) to restore your blood return. Yes good nursing care can reduce thrombotic occlusion but not entirely eliminate them. It is crucial to treat total and partial occlusions b/c left untreated the patient is at increased risk for infection not to mention you still have catheter dysfunction.

JemJ · Feb 24, 2011

Muno - what if there was a positive pressure cap on the PICC line, and then added the Y extender? That's what the nurse did. Would that cause blood to get stuck? Or would the positive pressure cap prevent that? Thanks!

MunoRN, RN · Feb 24, 2011

A positive/neutral pressure cap won't work as intended if it isn't at the junction that is being disconnected, having it between the PICC and an extension tubing causes it to just remain open all the time. That doesn't necessarily mean that the line is more likely to occlude because the cap is not located where it will function properly since there really isn't any solid evidence that they prevent occlusion, although there is a concerning amount of evidence that positive/neutral pressure connections increase the risk of infection. The purpose of the caps is to prevent blood from being pulled into the tip of the lumen when a syringe or tubing is disconnected. This is only an issue if you don't use positive pressure clamping (clamp the line while flushing), if you do that correctly then the caps really serve no purpose.