How to flush a PICC line

[Madame Poppy Pomfrey]

Hi everyone I'm a recent graduate on Med Surg unit for 3 months and I've had too many different preceptors, so consistency has been lacking especially with the veteren nurses. In regards to flushing PICC lines, the situation doesn't always present itself, but on dayshift orienting two different veteren nurses showed me the turbulent flushing method of stop and push. On the evening shift they finally gave me a consistent preceptor, (but I feel he is too young to precept and has only been an RN for 1yr.) ,he told me that method was wrong, and that I should just push the flush straight through to avoid sending out a clot. Don't get me wrong this preceptor clearly has more experience than myself but I don't feel too certain that he knows everything. I had understood the turbulent flushing help to clear medication and fibren from the PICC line. I mean technically, if the patient is going to through a clot, I think they would have the clot dislodged from either way of flushing. I'm just getting very frustrated because this person tends to nitpick the way I do everything! Your advice is most welcome thanks .

[nightingale, RN]

Turbulent flush is recommended but I am an old Nurse.... maybe that is old information

Perhaps we will hear from and instructor or someone who may be involved in the most up to date info.

[morte, LPN, LVN]

i too, was trained in the turbulent method....try checking with your iv team, if you have one, or staff ed......maybe even oncology since they would have much experience with picc's....good luck and keep us "old geesers" updated,lol

[augigi, CNS]

Does your facility have a written procedure for managing PICC lines? Otherwise I agree that I would ask your educator or IV specialist.

[gitterbug]

Go to the source, the Picline will have an insert on just how to care for/flush it written in the material. Check with pharmacy, they are so much help and we often overlook them.

[Daytonite, BSN, RN]

It bothers me a great deal that you would not trust someone's advice because you "feel he is too young to precept and has only been an RN for 1yr". The real issue here, as I see it, is not the flushing of the PICC, but an issue of attitude. Since you already seem to have a preference in mind, and if this is so important to you, then I would strongly suggest that you go to the library and do some research yourself instead of depending on the hearsay of others since you obviously don't trust what you have been told by two different people at work.

By the way, I was nationally certified in IV Therapy, inserted PICC lines and have been a nursing supervisor and unit manager. I was on IV teams for 6 years. Look at your facility policy because that is what you should be really be following.

[Madame Poppy Pomfrey]

Thanks everyone, I will check all of those resources in the hospital such as education, written policy, and pharmacy.

[Madame Poppy Pomfrey]

Oh and Daytonite I never said I didn't trust two different people at work what I said was, two different vetern nurses told me to do turbulent flushing, the young preceptor told me that was the wrong way and to do just a straight flush.

[Daytonite, BSN, RN]

I have plenty of weblinks to information on PICC lines, their care and maintenance.

[nightingale, RN]

moderator note:

please remember to not let comments become personal in nature. let's keep the conversation on helping with information not critiquing each others statements. interpretations can be misunderstood and steer away from helping one another.

[nightingale, RN]

It would be nice to know of some links on this topic. Care to share any? Feel free to post them here.

[Daytonite, BSN, RN]

to my knowledge there are no contraindications to doing either method of flushing. this is why you won't find a lot of literature that specifically talks about this. the main issue is that you don't try to push an obvious obstruction through the catheter that could result in pushing a clot into the patient's circulatory system, or use a syringe that is too small that creates large pressures in the catheter itself that will cause catheter rupture. our iv team advocated that any central lines, piccs in particular, be flushed with large amounts of saline solution if the patient was able to tolerate it. the reason is because the piccs have smaller lumens and are subject to getting occluded much more easily than a device that is larger and inserted by a doctor closer to the heart. we carried 20cc and 50cc syringes and flushed these ports with a minimum of 20cc of saline whenever we flushed, especially if we drew blood from a picc for labwork. we found that this kept these lines clear. still, it is difficult to troubleshoot for fibrin sheaths that form flaps around the distal ends of catheters. often, its takes a de-clotting procedure to dissolve them followed by fastidious flushing.

http://www.nursingcenter.com/prodev/ce_article.asp?tid=535139 - halfway through this article is information on flushing. both methods, straight continuous, non-interrupted flushing and "stop-start" flushing are addressed.

http://www.chartwellpa.com/pdf/patient_education/picc.pdf - this is a short procedure pictorial of how to flush and change the caps on a picc line. however, at the very end is a nice little table that nicely summarizes the major problems that can occur with picc lines, what the likely cause is and what you can do about it.

http://www.rncentral.com/library/clinical/clc.html - this is a chart that includes flushing guidelines, tubing and dressing changes for various types of central lines. unfortunately, it doesn't make a distinction with regard to "how" to perform the flush.

from the medical university of south carolina venous catheter tutorial:

http://www.musc.edu/medcenter/cvl/powerpoint/sld012.htm - about flushing piccs. . .

http://www.musc.edu/medcenter/cvl/powerpoint/sld013.htm - how do i flush a picc?