PICC line reflux and occlusions - page 3
Hi, I'm new to this site and I hope that I'm posting this question in the right place. I'm an RN and I'm having a difficult time caring for my own PICC line. It is a double lumen Bard Power PICC... Read More
0Jul 8, '11 by MunoRNBard's instructions on the use of a SOLO:
Recommendation for a "pulse" flush on page 3.
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0It really sounds as if.your valves may be damaged or you have a hole somewhere in the picc line. What you described should not be happening.,by any chance did they leave the stylet in to obtain your cxr. I will share where I got that info about biofilm but I am ln a mobile device and it takes me forever to type.
0I will e mail.my super iv nurse specialist that I consult on complex issues.
0Jul 9, '11 by alzrnMunoRN, Thank you for reminding me, I have that nursing guide saved on my computer. Bard does recommend the push pause technique for flushing to help clear the valves.
Maybe it is not necessarily the "push pause" action that causes the problem with shearing of biofilms but the excess force that some people tend to use with this technique?
Iluvivt, the PICC is supposed to be a SOLO2. It was placed feb 22, 2011. They used ultrasound and sherlock tip location. The dressing was done before x-ray. No adjustments were needed afterwards.
The reflux was first observed a few hours after placement, before it had been used for any infusions. The first occlusion occurred 3 days later. There have since been 6 more occlusions. Cathflo has been effective each time.
Iluvivt, Thank you for taking the time to think about this issue and discuss it with your knowledgable colleagues. I really do appreciate it.
0Jul 10, '11 by iluvivtI e mailed my friend..waiting for a reply. I must say that this sounds very much like the problem I used to see many many moons ago with the first design of the chest Groshong.......Blood kept refluxing back into the catheter b/c the slit valve (on the distal end of the catheter in this design} kept opening. The company had to redesign the valve. I remember when I first starting using the SOLO one (as I will call It) I would take my stylet out and and I would notice blood dripping out of my hub...so I would have to flush it until it stopped. I forgot to ask if this is a single lumen or a dual b/c if it s dual what I would like to know is only one lumen refluxing or is it both...perhaps the stylet which stays...... in place of course until the nurse insertor pulls post insertion damaged the valved on the way out.....do you know if there was a technique often called "wiring" performed during your insertion or if the stylet was put back into the PICC multiple times to confirm tip placement on a tip locating system...b/c the more I think about this the more I have come to think this is a valve problem. Those valves can be very temperamental esp if damaged.
Another option you can do if you do not want to get another PICC is to just treat it like a regular power PICC so all you are missing is the clamps. So do your flush..whatever you like..pulsatile or smooth and steady...then disconnect....you would have to get some little slide clamps....I used to take the Little blue ones off the extension tubing for PIVS and slide them on the tails if I had a valved catheter that was refluxing and I was sure there was no hole or other air source. Do not use anything metal b/c you do not want to damage the tails and make a hole in them. So flush ..disconnect..then clamp
0Jul 10, '11 by alzrnI originally had a regular Power PICC. It had the same problem with reflux which lead to frequent occlusions. I used the positive displacement LAD that was recommended, disconnected after flushing, then clamped. The blood would still reflux up to the clamps.
After several months of frustration they replaced the PICC with a double lumen Solo thinking that the valves would stop the reflux. The insertion was quick and seemed to be easy. I couldn't see anything because of the draping. So I can't answer about the stylet or wiring.
We were disappointed when the reflux problem persisted. It occurs in both lumen, flows right up to the valves and stops, it doesn't go past the valves into the extension sets.
At one point the PICC nurses recommended that I stop using the extensions. Then I could not self infuse, I always had to have a family member around to help me. When the reflux problem persisted I went back to using the extensions.
Some days are worse than others. Yesterday I noticed 7 episodes of reflux (think of all the extra flushes this requires!). Sometimes it only happens once or twice. I don't check every hour or anything like that, just randomly when I think about it.
My extension sets come with slide clamps (which I always throw away). I will open up a pack and try the clamps today just to see what happens. If it helps that would be a nice easy fix.
Thanks again Iluvivt. I know I can't be the only person out there with this problem.