Hello fellow nurses! I have a question for you all. I am new to home health (started about a month ago), but I've worked on an orthopedic/med-surg floor for just at a year and I still work that job also. But, anyway, yesterday I had a patient with a PICC line, we do weekly PICC line dressing changes on her and flushes. I've seen her 3 or 4 times before and another patient with a PICC line at my home health job, not to mention, I deal with them all the time at the Medical
Center... But yesterday for some reason, after I changed her dressing and hanged the cap and was about to flush, I seen a bunch of little tiny air bubbles in the line. This hasn't happened before, so of course I didn't flush, I pulled back to see if I could get the air out, I kept pulling until there was about 2 mL of air in my 10 mL NS syringe. I pushed the air out, and pulled more air out of th PICC. At one point, I thought I was going to be able to flush, but when I tried again, I saw those air bubbles once again! After about 10 to 12 more attempts of trying to pull air out and flush, I decided not to flush the PICC line. The patient is also an RN and agreed with me. She also goes back to the oncologist on Tuesday. It makes me wonder if it was a problem with the syringe or cap? I made sure everything was on tight. Never had this happen before! When I told my DON about it, she acted as if I should have flushed it anyway because it's not enough air to kill anybody. I don't understand that either, I wouldn't wanna risk it! I also never got any blood return. Has this ever happened to any of you? Thank you!
Apparently the equivalent of <2mL of air is SAFE to give to an adult patient peripherally (ie through a cannula), it will not cause any adverse effects. But CVL's and PICC lines are different stories, and you can only have very tiny little bubbles, if any at all. I wouldn't have flushed it either... just for liabilities sake!
Last edit by canned_bread on Jul 7, '12
: Reason: wrote 5mL not 2mL by accident!
Jul 11, '12
Odd. I would wonder if the PICC has flipped (in RAD they have sometimes flipped a PICC back into place by using forceful flush, but had one patient whose PICC flipped upward when they injected meds and he began feeling the burn of the morphine; when x-ray was done to confirm location, sure enough the PICC was angled toward his head where he had been feeling the burn!) or if there is a breach in the line somewhere that is hard to visualize (tiny breaches might occur and allow air to be suctioned into the line depending on where the breach is located; I have even had a patient whose catheter had broken inside the body (x-ray confirmed damage and the line was removed safely).
Also, if no blood return, you always want to do a repeat x-ray to confirm placement. No. I would not have flushed. If tiny breach/split in line, PICC will have to be replaced.
Last edit by maelstrom143 on Jul 11, '12