little clamps on peripheral IVs and PICC lines. . .

[ArtsyCraftsy]

Hi everyone,

I'm a new nurse and am puzzled about those tiny little clamps that are on the peripheral IVs (you know, the ones you slide back & forth to clamp and unclamp) and the ones that are on PICC lines and Central lines (the ones you squeeze to clamp and unclamp)

I guess this is a dumb question, but do they ALWAYS need to be closed when something is not actually going in? If so, why? WHAT ARE THEY REALLY FOR?

I had noticed in my clinicals that in some hospitals the peripheral IVs didn't have these clamps, so I'm wondering what is the purpose of these clamps?

Should you open them before or after you attach your syringe or IV line? Does it matter?

And when do you close the clamp after a flush? Do you close it before all the liquid gets in?

I couldn't find any info on the internet about this, and I feel so ignorant and clueless.

If you can, please provide info about the peripheral IV access devices and also PICC lines and Central lines.

Would appreciate any info! Thanks!

[AgentBeast, BSN, RN]

Those clamps are there to create "positive pressure" and prevent the back flow of blood into the line that might clot off and occlude the lumen. The procedure is to alcohol the port, connect your syringe, open up the clamp, flush the line, close the clamp just before you finish flushing all the fluid into the line , and finally disconnect the syringe.

With peripheral IV's if you are doing something like flush to check for patency, med, and lastly flush, it is only necessary to close the clamp after the final flush. With central lines you close that clamp before you disconnect every syringe.

[turnforthenurse, MSN, NP]

I always clamp them off so that air does not get into the line, especially for central lines (what if those little blue caps were to come off? air embolus!) - but I'm talking about the clamps on the lines themselves, not on the IV tubing.

I always attach my flush first, then unclamp and flush. Reclamp before taking the syringe off and always keep it clamped when not in use.

[BunnySan27]

I agree with above posts, nothing like coming on and you discover your patients PICC line is unclamped and surprise! It's occluded.

[Dixielee, BSN, RN]

I agree with above posts, nothing like coming on and you discover your patients PICC line is unclamped and surprise! It's occluded.

Or worse yet, the cap has come off and your patient has bled out. I walked in to a patient whose central line cap had come loose and blood was dripping onto the floor! Very scary moment!!

[bozkurt]

Catheters with a clamp are the Non-Valved catheters. Must be clamped at all times when not in use. Requires heparin to prevent back flow of blood into catheter, causing clot formation. Catheters without clamp are Valved catheters, have pressure sensitive valve and no heparin needed when flushing.

[littleneoRN]

When in the process you clamp (before or after removing flush syringe) depends on the brand of cap. Some are positive pressure caps and require a different process than the other ones, which I think can be neutral or negative. I do now know the ins and outs of all this, but it makes it important for you to know what brand cap you have and the specific process for that type of cap and the associated line. Check with your unit educator on this one!

[AnonRNC]

Artsy, while this may seem like a little thing that you 'should' know, I would counter that this is a 'little thing' that many nurses let slide. I love that you are asking questions about the small details.

[AJPV]

Is a Power PICC one of the valved central lines that does not need to be clamped? I seem to remember something like that from my class, but not clearly enough to trust my memory.

[njmomstudent]

If you are working with alot of patients with PICCs I highly suggest the clinical nursing skills book by smith, duell and martin (its a really really good book, especially for a new nurse to take to work incase you don't want to ask coworkers about a procedure you need to do). There are different kinds that you DO NOT flush with heparin or clamp because it can damage them, etc. (mostly the ones that have valves). Also, they should have taught you never to use anything smaller than a 10mL syringe with them because the increased pressure from smaller ones can damage them as well. Something that isn't in the book... if you have a double or triple lumen, they will be marked proximal to distal. Basically, when you need to get blood from it, you will want to get it from the proximal one, because the ones further down should have fluids, meds running in that you won't want to mess up the sample with. HTH!!!

[psu_213, BSN, RN]

Where I used to work, we were not supposed to clamp the "new" model of PICCs being used in the hospital. An IV team nurse basically yelled at a nurse on the because she clamped a PICC. The IV nurse said that the PICC has a built in positive pressure valve and did not need the be clamped. The clamps were only there for cap changes. Then again, I had some questions about knowlege...and defnitely the professionalism) of the IV team there. It drove me nuts when they kept calling an implanted port (portacath) a 'Hickman.'

Sorry, getting off topic. Part of the reason for clamping PIVs is that blood will back up into the catheter/tubing, then it will clot, and then you will have a useless line.

[wooh, BSN, RN]

When in the process you clamp (before or after removing flush syringe) depends on the brand of cap. Some are positive pressure caps and require a different process than the other ones, which I think can be neutral or negative. I do now know the ins and outs of all this, but it makes it important for you to know what brand cap you have and the specific process for that type of cap and the associated line. Check with your unit educator on this one!

Definitely check with your hospital educator or IV team to get the lowdown on the brand and type YOUR facility uses. Ones that "look like" other ones can be very different.

This is one of those things where you should never feel stupid using your resources, because it varies too much for us average nurses to keep up while we're keeping up with everything else. Varies by brand/valves/lumen size/number of lumens/age of patient/weight of patient. Use your resources! I've got my facility's protocols for pretty much every kind line we use memorized, but I'll still check if I haven't had a PICC in a while or a port in a while and if I ever get one that was placed at a different facility, I definitely double check before assuming it's the same as what we normally do. Educators are hired to answer questions like this. And believe me, IV teams would much rather come and share info on the preventative care of lines than have to come later and try to fix the line! Make use of their expertise!h