PICC lines

indeed · Aug 26, 2002

1. How do you maintain them?How do you prevent infection? Prevent them from obstructing? Prevent any adverse problems?

The key to maintaining a PICC is flushing them religiously...I have seen those suckers clot off after thirty seconds of no flow on an IV. Most places have a policy in place, and it's standard to flush with Heparin. There should also be a policy about dressing changes, which are sterile and done pretty much like a central line.

2. How do you administer drugs thru them?

Same way you administer drugs through a peripheral IV site, only the last flush will include Heparin. The lumen is usually small so you will feel more resistance in a PICC when pushing meds, but other than that, it's pretty much the same.

3.Any thing you have learned about them you would like to share?

4.What never,ever do when caring for a PICC?

5.What you should always do when caring for someone with a PICC?

6.Any experience,info,tips, and dos and donts about PICCs

Thanks

The answer to all these questions is the same for me....KEEP IT PATENT. If not being used for continuous infusion, PICCs need to be flush at least Q8H. And if something is infusing, and it alarms, try to get at it ASAP. It doesn't happen all the time, but it can clot off almost instantly in some people. Also, it should come with tons of documentation...find out if you can draw labs through it. This will save your patient a lot of pain, and it will save you a lot of time (if you're the one who draws labs in your facility). Hope this helped. Good luck!

Indeed.

neneRN, BSN, RN · Aug 27, 2002

All of the above, and NEVER use smaller than a 5cc syringe; it causes too much pressure on the line and can ruin it.

Our hospital uses 3cc of Heparin solution to flush, but you have to make sure it's not a Groshong, which can only be flushed with saline. NH pts who come into our ER with them often don't have it documented wheter its a Groshong or not, but there is some TINY print on the catheter itself if it is.

Sleepyeyes · Aug 27, 2002

Ok, I think this is a nice site and you can also get CEU'st::::

http://www.baxter.com/doctors/iv_therapies/education/iv_therapy_CE/Basic_One/Basictwo2.html#blood

One of the biggest problems I had in the nursing home was the interchanging of the terms "PICC" and "midline." Very different, make sure you know which one you've got. You won't usually get a blood return from a midline, the cath is softer. But you will from a PICC. Also, never draw blood from a midline. Same reason--cath will collapse.

Good luck! and remember to consult your Policy & Procedures manual for important info too.

kewlnurse · Aug 27, 2002

We use a 10 cc to flush, had a few blow with 5cc, and always infuse with a pump, never to gravity. Change the dsg q week and prn

shannonRN, BSN, RN · Aug 27, 2002

my hospital's policy and procedure...

1. may use midline/deep peripheral catheter after insertion is complete.

2. no chest xray required.

3. 10cc needless syringes only.

4. no blood pressures in cannulated arm.

5. contrast dye cannot be injected through this catheter.

6. run all iv infusions with infusor pump.

7. 10cc 0.9% nacl primary flush, q12 hour prn with antibiotics (flush after each use).

8. if catheter is heplocked, flush cath q8 hour with 5cc heplock solution using 10cc interlink syringe. if infusing intermittent meds, use sash method with 10cc syringe only, clamp t connector at all times when not in use.

9. catheter may be used for blood draws using central line protocol. use 10cc syringe only.

10. for maintenance of catheter call iv team.

11. do not discontinue catheter, call iv team.

12. no "central line only" fluids to infuse through catheter.

saw this thread before i left for work and had a second to print it...hope it helps!

renerian, BSN, RN · Aug 27, 2002

I would check your P&P as some docs use heparin and some do not..............................................measure the distance catheter is out at every dressing change to make sure it is not migrating. Helpful if the record has the original measure so when it is pulled you can verify a piece did not break off..........

your facility should have these for you to work with.......

renerian

starr234 · Sep 5, 2002

If a central line or picc line is clogged, what do you do to remedy this problem?

renerian, BSN, RN · Sep 5, 2002

You can put a substance in it called urokinase. You gentley instill it with a tb syringe. You tape the syringe to it. You let it sit. Little by little it will hopefully break up the clot in the line. Need an order and sometimes we could not get this product due to decreased supply. When you are done withdraw the med and flush it. May then need an order for heparin to keep the problem from recurring. I have seen alot of piccs clot off without heparin. This is how our policy reads to do this proceedure. Sometimes lines may appear to be clotted though and repositioning the client or raising their arm above their head will help.

renerian

renerian, BSN, RN · Sep 5, 2002

Forgot to say not to ever force the med or a flush into the line.....''renerian

Sleepyeyes · Sep 5, 2002

Originally posted by renerian
You can put a substance in it called urokinase. You gentley instill it with a tb syringe. You tape the syringe to it. You let it sit. Little by little it will hopefully break up the clot in the line. Need an order and sometimes we could not get this product due to decreased supply. When you are done withdraw the med and flush it. May then need an order for heparin to keep the problem from recurring. I have seen alot of piccs clot off without heparin. This is how our policy reads to do this proceedure. Sometimes lines may appear to be clotted though and repositioning the client or raising their arm above their head will help.

renerian

Our facility policy for that problem was to call the IV Team, although we'd try the repositioning or arm-raising first. :)

Editorial Team / Admin · Sep 6, 2002

The PICC lines that are Groshongs have a special valve that supposedly prevents backflow of blood into the catheter that may clot it off. Policy at our facility is to flush with saline q 8hr if not being used. We also use a "clotless clave" - CLC 2000 - on the end, that exerts a continuous positive pressure within the cath, to also prevent blood backflow.

The RADPICC catheters - usually dual lumen - that the Radiologists put in with ultrasound and fluoro, are open-ended (no Groshong valve) and need to be flushed per policy; at our facility that is q 12 hr with 100units/cc heparin, 1cc per port. We also use the CLC-2000 with these lines. Based on the literature I've seen, I'd like to see only saline used to flush any of the PICCs, as long as the CLC-2000s are used, but our facility hasn't adopted this as policy. Yes, I have explored the channels; people seem to have other priorities.

Nothing but 12cc syringes used to flush.

No iodine contrast, only because you can't inject fast enuf to get good contrast filling, and you aggravate your carpal tunnel just injecting 10 syringes' worth just to get 100cc of contrast in!! I refuse to do it, and the Radiologists don't want to, so I'll try to start an IV if pt needs contrast CT study. We don't inject thru them with the power injector, either, if anyone was wondering.