Flushing/heparinizing PICC line before and after peak and trough?

[nervousnurse, ASN]

Hi! first I have to say, I ALWAYS read our policy and procedure book for anything I'm not familiar with, but THIS particular

issue is NOT addressed in our book, so I just asked the charge nurse, since I'm new to PICC lines.

I drew a peak (or was the trough first, can't remember) anyway, drew the lab, then hung the Vanco. I knew that

the next lab draw (peak or trough) would be drawn in an hour. My common sense told me to of course flush the

line w/ saline, but NOT follow w/ heparin because someone would be drawing from it in only an hour, and of course

they, too, would be following the saline w/ heparin.

....I of course

don't want the line to clog, but assumed the saline would be enough for just an HOUR... My charge nurse said to go

ahead and finish w/ heparin. Am I wrong to think an hour later, when the next nurse ALSO heparinized him after,

drawing the lab, it would be too much? Mind you, it's only 3 cc's of heparin each time (but within an hour of eachother?)

Of course my concern is for the patient....

Can't wait to hear what more experienced peeps have to say!

[KateRN1]

Interestlingly, I dealt with a similar situation this week at my agency, which has no P&P at all. In short, it depends on the type of PICC you're using. Some require heparin, some don't. A PICC that requires heparin should have a heparin flush after every use. The lumens are so small that microclots can occur and occlude the line quickly, especially when used for blood sampling. The amount of heparin that is in a heparin flush is so minute that it should be a problem for most patients. Heparin flush is either 10u/ml or 100u/ml, neither amounts to much for anticoagulation purposes, clears very quickly, and unless the patient has a history of HIT, shouldn't be an issue. The patency of your PICC is much more important.

Since you don't have a P&P to address this, I would suggest googling the PICC brand to see what the manufacturer suggests.

BTW--the trough is drawn first because that should be the lowest blood concentration of the drug. The peak is drawn one hour after administration because that's when there should be the highest concentration of the drug in the blood.

[stndgfrm]

I'vebeen taught that when a line is to have a hep. flush to do it. And they have to flush the line, draw up, discard that and then draw up again, followed by th flush of saline then the heparin anyways. But it has bee awhile since I have done this.

[KateRN1]

The amount of heparin that is in a heparin flush is so minute that it should be a problem for most patients.

That should be "it should NOT be a problem . . ."

Not sure why I didn't have the option to edit it.

[cardiacRN2006, ADN, RN]

You drew the trough, but then you have to wait the 2 hrs for the vanco to finish, and then draw a peak 1 hr after admin. If this was a PICC that needed Heparin, then it needs heparin. So aren't we talking 3 hours here?

And, does anybody still do peaks? We only do troughs.

[*ac*]

You drew the trough, but then you have to wait the 2 hrs for the vanco to finish, and then draw a peak 1 hr after admin. If this was a PICC that needed Heparin, then it needs heparin. So aren't we talking 3 hours here?

And, does anybody still do peaks? We only do troughs.

We do peaks for some drugs, not usually vanc.

[DManAZRN]

I think the first answer you got would be the best, and yes the trough is first for that exact reason.

The equipment is pretty specific. Ask for information on your particular PICC brand. Our PICC lines are now larger and some are "power picc's" that they can run a high volume at high rate, which tells me it's an even larger lumen.

We now use "autoflush" caps that supposedly eliminate the need for heparin flushing entirely. We simply flush with 20cc of saline after blood draws, 10cc after med infusions or pushes. They cited a study about heparin flushing not being neccessary anymore even for peripheral IV sites. So we only use saline flush for peripherals too now. It will just depend on the PICC itself, and the type of cap placed on it. As far as the peak, we draw one hour after the infusion completes, your P&P for peak and trough (should be called trough and peak really...) should be there somewhere, but to save time, I would ask the laboratory manager or other knowledgable individual.

[nervousnurse, ASN]

Thank you for your replies! Very helpful!!!