knowing how to maintain a PICC line

A valved PICC line (one that is closed and does not need to be heparinized) does not have clamps for you to manipulate; however a non valved PICC line (one that is open and needing to be heparinized) will have clamps for you to open when using and to close after flushing off. So if you see a PICC with clamps, it is certainly non-valved and if you don't see clamps, it certainly is valved.

I worked at University of Washington Medical Center for a number of years and this how we were taught to differentiate. It was not uncommon though to have a pt with a valved PICC that would repeatedly need tPA due to clotting off, so there are the occassional pts that do need their valved PICCs heparinized.

Here is just some general stuff, common P&P from facilities I have worked in...

In an inpt setting it is standard to flush and check blood return in the PICC Q8H. In outpt setting it is done on a Qday basis, the pts should know how to do this and have the supplies at home.

You may already know this, but anytime you draw back blood you ALWAYS flush with 20mL NS, otherwise 10mL is acceptable. PICC dsgs need to be changed QW & PRN using sterile technique (chloraprep cleanse, biopatch, sorbaview or tegaderm type dsg, stat-lock, etc.). Claves should be changed at this time as well, otherwise Q3day. You should measure for a change in external length while changing the dsg, anything greater than 2cm is concerning - some facilities require CXR to reconfirm placement at that point.

additional info for PICC line maintenance from one who works in home infusions, we always measure mid arm circumference when doing a dressing change as another way to evaluate the PICC. I can't stress enough also to make sure the area that you cleanse is COMPLETELY dry before applying the dressing. Many patients end up with a rash similar to a first degree burn because chloraprep which is very caustic, is still wet/damp and placed underneath an occlusive dressing. Also, many patients come to us from the hospital setting without the dressing being completely sealed. A piece of sterile tape or the part that comes with the dressing needs to be UNDER the PICC and another piece OVER the base of the dressing to prevent bacteria from having an easy entry under the dressing.

I teach my home care patients, that if they are hospitalized they need to make sure their nurse washes their hands, Scrubs the Hub, flushes with at least 10 cc after blood draws and is trained and competent in PICC line/CL care prior to touching their line. Line infections cost millions of dollars every year as well as risk to the patient's life. Simple steps take care of and prevent them. No excuses of being too busy to provide quality line management are acceptable! :)

Since proper maintenance of PICC lines vary depending upon whether it is an open or closed end catheter, how do you know how to care for it if the patient doesn't know what type of catheter they have and the catheter was placed at another facility? If you don't know wouldn't you heparinize it? If so, isn't that introducing risk to the patient they might not need to be exposed to?

Where can I find definitive recommendations for maintaining the various types of PICC lines. All I can really find is the general statement "follow your facilities policy/procedure". That's the problem, we need to establish our facilities policy/procedure.

Do you always flush both lines of a double cath PICC when only one is used?

What is the practice at your facilities?

You can always go to the manufacturer of the line. Each one will have IFU on their home page.

And yes, if you have a double lumen PICC, both lumens need to be flushed on a regular basis to prevent occlusions. Contrary to some nurses beliefs, multi lumen IV catheters, do NOT merge into one.

I am very interested in picc lines. Someone I know has one and it always has blood around the insertion point, it looks like a lot of blood under the tegaderm, but it is really a small amount. We were wondering is that normal? There is no pain or heat and the home health nurse changes the subject an I am only a nursing student. I did learn from the previous posts that it is an open picc line.

I am very interested in picc lines. Someone I know has one and it always has blood around the insertion point, it looks like a lot of blood under the tegaderm, but it is really a small amount. We were wondering is that normal? There is no pain or heat and the home health nurse changes the subject an I am only a nursing student. I did learn from the previous posts that it is an open picc line.

It should not have blood around the insertion site. Is the IV catheter getting pulled on? This blood at the insertion site becomes a perfect medium for bacteria. Whenever the dressing is loose, soiled or the site has blood under it, a sterile dressing change with mask, sterile gloves etc should be performed. Is your home health agency doing all the dressing changes?

The home health nurse is doing the dressing changes but they give us a hard time when we ask for more than one at a week. The paper the hospital gave us says twice a week. They wont let me, because I "wont use sterile procedures" But the home health nurse will rummage aroun in her purse with sterile gloves on. The Dr just said change the bandage more often. The picc line is on an 8 year old boy so it is hard to keep still.

The home health nurse is doing the dressing changes but they give us a hard time when we ask for more than one at a week. The paper the hospital gave us says twice a week. They wont let me, because I "wont use sterile procedures" But the home health nurse will rummage aroun in her purse with sterile gloves on. The Dr just said change the bandage more often. The picc line is on an 8 year old boy so it is hard to keep still.

Well as an specialist in Infusion Therapy, I can understand your concern. The "norm" is to change the dressing covering a PICC line q 7 days and prn (As necessary), but some institutions do do it more frequently. You are right in saying that it is hard to keep an 8 year old boy still, and the dressing clean, dry and intact, but attention needs to be paid to the dressing frequently to ascertain that it remains intact. Depending on the size of your 8 y/o, covering the arm work well to keep it from getting pulled on. There are commercially designed products that will aid in this, but I've also seen great success with large mens tube socks (not used of course) but straight out of the package, and the foot cut off. That way, the tube slips right over the arm and the dressing therefore stays intact. Great care should be taken when this tube is removed, however, to prevent the catheter from getting pulled on. (The tube should NOT be tight fitting around the arm, but rather provide a good covering) Also, it is important to protect the catheter/drsg so it does not get wet in the bathing process.

As far as the nurse going into her purse "during" the sterile procedure, I pray that it isn't being done "during", but after the dressing change was completed. Otherwise you have a break in sterile technique, and new sterile gloves needed to be donned, but only after alcohol hand gel was used and your hands were rubbed dry.

Talk to the HH nurse about your concerns, or the Director of the home health agency. Perhaps a site visit needs to be done by the DON and nurse to assess competencies. Competencies should be done at least yearly by the head of the agency to ascertain that everyone is "still on the same page" with practice criteria.

Hope this helps.