Since proper maintenance of PICC lines vary depending upon whether it is an open or closed end catheter, how do you know how to care for it if the patient doesn't know what type of catheter they have and the catheter was placed at another facility? If you don't know wouldn't you heparinize it? If so, isn't that introducing risk to the patient they might not need to be exposed to?
Where can I find definitive recommendations for maintaining the various types of PICC lines. All I can really find is the general statement "follow your facilities policy/procedure". That's the problem, we need to establish our facilities policy/procedure.
Do you always flush both lines of a double cath PICC when only one is used?
What is the practice at your facilities?
A valved PICC line (one that is closed and does not need to be heparinized) does not have clamps for you to manipulate; however a non valved PICC line (one that is open and needing to be heparinized) will have clamps for you to open when using and to close after flushing off. So if you see a PICC with clamps, it is certainly non-valved and if you don't see clamps, it certainly is valved.
I worked at University of Washington Medical Center for a number of years and this how we were taught to differentiate. It was not uncommon though to have a pt with a valved PICC that would repeatedly need tPA due to clotting off, so there are the occassional pts that do need their valved PICCs heparinized.
Here is just some general stuff, common P&P from facilities I have worked in...
In an inpt setting it is standard to flush and check blood return in the PICC Q8H. In outpt setting it is done on a Qday basis, the pts should know how to do this and have the supplies at home.
You may already know this, but anytime you draw back blood you ALWAYS flush with 20mL NS, otherwise 10mL is acceptable. PICC dsgs need to be changed QW & PRN using sterile technique (chloraprep cleanse, biopatch, sorbaview or tegaderm type dsg, stat-lock, etc.). Claves should be changed at this time as well, otherwise Q3day. You should measure for a change in external length while changing the dsg, anything greater than 2cm is concerning - some facilities require CXR to reconfirm placement at that point.
Last edit by sdeal on Aug 16, '11