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 Solo. I use MaxPlus positive displacement caps. The problem is, I have frequent spontaneous blood reflux that fills my lines. This has caused several occlusions (requiring expensive cathflo treatments) and I've only had the PICC in for about 4months. I am on twice daily antibiotics and IVIG. I have poor venous access so I need this PICC line.
Do you all have any suggestions? Is there anything I can do to prevent the blood refluxing? It happens multiple times daily. I am careful to use the positive pressure flushing technique. The PICC line nurses at my hospital have not been able to figure out what is causing this problem. They say it shouldn't happen. I had another Power PICC with the same problem that was pulled and replaced for this reason, constant blood reflux and frequent occlusions.
I would greatly appreciate any advice.
Well you ask some really good questions. Yes the idea of a push pause technique or pulsatile flush came about in the 90's and many are still performing a flush this way. There are several ways to classify a cap or LAD but for this discussion we will just say they can be negative,neutral or positive displacement. The RN absolutely needs to know what kind of LAD is on their CVC so they flush it properly. There has been a lot of controversy about the positive displacement valves causing an increased infection risk in the literature so many have switched to the neutral caps. As far as catheter fracture goes there can be many symptoms...the patient may complain or report a feeling of pain or a cool sensation or an aching sensation at the location of the hole. If you have a pt that is getting Vancomycin through a PICC and during infusion they complain of pain at a very specific place in their arm along the course of the PICC suspect a fracture. If the fracture is close to the catheter skin junction you will often get backtracking or leaking at the insertion site. I ALWAYS must know the history of the catheter...how long has it been in place.....where is the tip....has it had Tpa recently...has there been recent problems of any kind....has the patient had excessive physical activity...any crutch use.
You do not want the catheter pinched or occluded in any way b/c that can create a pressure change and cause reflux. Most of the problems I have seen with catheters being butted up against the wall of the upper SVC have been with left sided approach catheters ,especially when the MD did not quite measure accurately and barely made it into the SVC at all. So yes you want good hemodilution but you also want the catheter floating freely.
Ever good PICC nurse I know views the film after they place the line and if we disagree with he radiologist we certainly will have a discussion about it. You can trust your CXR read. The most important thing you can do to maintain a good tip position is to not pull out the catheter at ALL during dressing changes b/c every complication increases the farther away that tip gets away from the low SVC/cavo-atrial junction.
When BARD first put out the SOLO there were some complaints about the valves so they changed the pressure sensitivity so now it is the SOLO 2. I do find the SOLO 2 much better than the original SOLO.
There is no current recommendation about the frequency of CXRs after the initial line placement verification. So yes if there are any s/sx of malposition a CXR needs to be done. If there is a significant change in the amt externally visible on a CVC,especially a PICC a CXR needs to be done. A nurse also needs to know the original tip location and the amt externally visible. If a patient comes into a health care facility the RN must verify tip placement before using any line. This can be done be verify the it by medical records but what usually happens is that a CXR is ordered. A blood return alone does not guarantee that the CVC is safe to use,
Last edit by iluvivt on Jul 3, '11