how to flush a picc

[me5115]

I work at an out pt cancer center, most of our pts have mediports. sometimes we end up with pts with picc lines. none of us are exactly sure how to flush them. We were told if it is a gershong it only needs flushed with saline. If it is a plain picc line with a clamp it needs flushed with saline and heparin. Does that make sense?

[iluvivt, BSN, RN]

Here are general guidelines,but your employeer should have specific flushing protocol for you to follow. A Groshong PICC is made of silicone with a special 2 way valve at the distal end. It is either open (when infusing or flushing) in a neutral position (neither flushing or withdrawing) or overridden to obtain blood samples. When locked off it can indeed be flushed weekly with normal saline only or heparin can be used. (it will not harm the catheter). Any catheter should be flushed with approx 2.5 times its priming volume. PICCs have a low priming volume (less than 1 ml) so....most PICCS can safely be flushed with anywhere from 5ml NS to 20ml NS. If you use Heparin this should be your final flush ( range on strength is 10 units per ml to 100 units per ml). All caps should be changed at least weekly with dressing changes at least weekly using sterile technique(including mask). Some will say open-ended PICCS need to be flushed more frequently though ONS (Oncology Nurses Society) recommendation on these lines is also weekly as long as they are locked lumens and they recommend 100 units per ml of Heparin as a final flush. All the PICC valved catheters on the market can be used as saline only flush if you desire. Most open-ended non-valved PICCs require Heparin if you want to keep the occlusion rate low. You do not have to use Heparin on these lines but we have found when we do not our occlusion rate is very high.