PICC Lines With Heparin

[mangua]

When using a PICC line that is heparin locked, do you pull off the heparin before using it?

[FLArn]

In my experience, usually the PICC is flushed with NS prior to use to clear the heparin. In most cases, unless the PICC has a lumen that is designed for blood sampling, they are too narrow to aspirate without collapsing.

[RNChristy]

If Heparin is used, you should pull off the heparin. The PICC lines that I used at our facility did not use Heparin. It was actually discouraged with the brand that we used. Maybe you have a policy or procedure at your facility that you can check. Also, check with manufacturer's brochure to see if Heparin should be used. Hope that helps.

Christy

[Sun0408, ASN, RN]

We pull it off before each use.. After the use of one of the ports; heparin was put back in to prevent it from clotting off.. Q12 hours all the ports had to be done.. We had to remove the heparin, flush with NS and then add new heparin..

[Tait, MSN, RN]

We no longer use heparin on our PICCs. Prior to that we would flush with NS, instill meds, flush with NS and then follow with 1ml heparinized saline.

Sounds like a policy check with your educator or manager would be the best route to go here.

[IVRUS, BSN, RN]

When using a PICC line that is heparin locked, do you pull off the heparin before using it?

Open ended, non-valved IV catheters should have Heparin flush 10unit per ml instilled into them after the saline flush. Though many hospitals have tried getting away from heparin flushing, it is the only solution we currently have in the US to decrease occlusions. Using this concentration, or even the 100unit per ml, WILL NOT cause issues with flushing, and therefore need not be drawn off prior to saline flush.

Dialysis catheter's use a much higher heparin flush concentration and these are drawn off.

Most PICC catheter's are 4 or 5 french and will NOT collapse with gentle aspiration to obtain the blood return.

Now, vigorous withdraw using a large 10 cc syringe or greater can definetly cause issues.

[FlyingScot, RN]

Using this concentration, or even the 100unit per ml, WILL NOT cause issues with flushing, and therefore need not be drawn off prior to saline flush.

We pull off the Heparin, not because of flushing issues but to reduce the risk of HITS. Our PICCs are very long-term and nobody is quite sure absolutely what causes it but there is suspicion that long term, repeated exposure to Heparin might be part of the cause.

[IVRUS, BSN, RN]

But HIT is not concentration dependant. Drawing it off makes little sense in the respect that one "usually" flushes with 3 or 5 mls of Heparin flush solution as the final SASH protocal. Given that most PICC lines have ID of approx 1.5-2 mls... Heparin will and does reach systemically when "locking". SO, you're under a false assumption that your protecting your pt with this method. And you are increasing infection issues with that draw.

[FlyingScot, RN]

Never said it had anything to do with the concentration and we don't flush with 3-5ml. We flush according to what the manufacturer says the priming volume is. Also, since I follow aseptic technique including mask, sterile field and sterile gloves I sincerely doubt I'm increasing the chance of infection. There is no "false assumption" here...I'm a lot smarter than that. Not only that, but the way we do it follows EBP. I'll try to find the references for you if you'd like.

[K+MgSO4, BSN]

We have stopped using Heparin on our PICCS and central lines. we use positive pressure bungs from Clave called a CLC 2000. It has a spring in the device which maintains a positive pressure reducing the back-flow of blood into the PICC

[IVRUS, BSN, RN]

Never said it had anything to do with the concentration and we don't flush with 3-5ml. We flush according to what the manufacturer says the priming volume is. Also, since I follow aseptic technique including mask, sterile field and sterile gloves I sincerely doubt I'm increasing the chance of infection. There is no "false assumption" here...I'm a lot smarter than that. Not only that, but the way we do it follows EBP. I'll try to find the references for you if you'd like.

You wear a mask, place a sterile field and wear sterile gloves to flush an IV catheter? Hmmm... No studies out there which show that this is the norm, or standard. And, these steps alone are NOT enough, as the increase infection risks will come from increasing hub manipulation. The way "we" do it Follows INS guidelines. Infusion Nurses Society that is.

[IVRUS, BSN, RN]

We have stopped using Heparin on our PICCS and central lines. we use positive pressure bungs from Clave called a CLC 2000. It has a spring in the device which maintains a positive pressure reducing the back-flow of blood into the PICC

A CLC2000 cap is a positive displacement device, not positive pressure, and yes, though these claim to enable you to eliminate heparin flush in open ended IV catheters, I don't see it working well in many settings. How much Cathflo have you used since this new cap was implemented?