Number of silly questions about PICC lines

Altra, BSN, RN · Dec 5, 2012

What do your Google searches have to say about PICC insertion sites and size of syringe used with PICCs? I'm not sure what is being asked in your 3rd question.

RunninOnCoffee · Dec 5, 2012

Most PICC's I see are in the upper arms. Never really seen one in the AC before. We use a lot of central lines in our ICU that are very similar to PICC's that I have seen placed in the IJ, EJ, Femoral site, and subclavian. Ours are flushed Q8 just with a NS flush, not with heparin. I think that just depends on your hospital. Never heard of open end or closed end.

Nurse Kyles, BSN, RN · Dec 5, 2012

At my facility PICC lines are usually placed in the basilic. A 10 ml stringe needs to be used on PICCS verses a smaller syringe due to the amount of pressure exuded. The smaller the the syringe the larger amount of pressure. This can cause damage to the catheter. ( and think about where the tip of the catheter is if it were to break or split).

I am not sure about your last point. We use lure lock caps on the end of our central lines.

CrystalSSA · Dec 5, 2012

Biggest thing, know the difference between a PICC line and a perm cath. I too have never seen an AC Picc...I've seen them just about everyplace else. We dont use heparin, that is hospital specific though.

K+MgSO4, BSN · Dec 6, 2012

The COOK turbo power injection PICCS are open ended internally.they allow for rapid inject of CT contrast with a lower risk of fracturing the line than a standard PICC with a more closed tip.

The smaller the syringe the higher PSI exerted thus higher risk of fracturing.

Choice of heparin vs NS is hospital dependent. There are devices available that cause positive pressure on the PICC that eliminates the need for heparin such as a Clave CLC 2000. Have a chat to your iv team or someone who works in oncology.

iluvivt, BSN, RN · Dec 7, 2012

1.A PICC line stands for Peripherally Inserted Central Catheter so it is accessed from a peripheral vein in the arm. Yes, they still can be placed via a traditional venipuncture method and without the use of Ultrasound (US) technology and tip location and tip confirmation systems. You would then see them placed from the Basilic vein (first choice)and Cephalic vein. Nowadays most clinicains use US to access the Basilic,Brachial land Cephalic veins. The benefit of using US is immense which I will not get into now. Also you need to know that the tip needs to be in a central vein at the low SVC or cavoatrial junction. The tip location is extremely important to minimize all complications but especially thrombosis. A PICC is a type of a Central Venous Catheter.

2. Most PICCs on the market are open-ended. The Groshong by BARD will have distal slit valve and thus the tip will look rounded and black. Bard also has the SOLO2 which has 2 valves in the tails of the CVC at the proximal end just past the hub. The valves are in the the smooth egg shaped part near the hub. Another brand is the PASV (pressure activated Safety valve) is also in the tails near the hub.The SOLO AND PASV will be opened ended but still they are valved catheters with all the benefits of a valve.

3. Each manufacturer will list the PSI of their PICCs in their IFUs. A 10 cc syringe is recommended because a smaller syringe can generate too much pressure (PSI exceeded) and this can weaken,fracture and even embolize the PICC. Will not get into the actual numbers.If you are going to administer something in a smaller syringe you can absolutely do that IF and ONLY IF you have verified patentcy and a blood return and it flushes with ease and without any resistance. It is much safer to leave the medication in the smaller syringe if it is a small volume and it has been prefilled with medication from a manufacturer. I am aware that some get confused on this concept but this is the current recommandation from infusion experts.

classicdame, MSN, EdD · Dec 7, 2012

less than 10 cc syringe can cause the line to fracture. Does not matter what volume is in the syringe.

Please ask your Educator to do an inservice on the care and maintenance of PICC lines. I get the manufacturer's rep to come in once a year with a PICC certified nurse to teach our staff.

sbostonRN · Dec 7, 2012

It's not really called open-ended or closed-ended. It's referred as "valved" or "non-valved". If it's valved it will not have a clamp on the external part of the catheter. There is a valve at the tip of the line that prevents backflow of blood when a syringe isn't attached. Non-valved PICC lines have clamps.

I have seen PICC's inserted in the arm, which either exit the vein at the AC or within 3 inches above the AC. I've also seen one inserted into the femoral vein in the groin because the patient had extremely poor upper extremity access.

As far as the size of the syringe, it is related to the pressure exerted against the catheter. At my old job we used a special type of BD syringe. They exerted the correct pressure no matter what the fill size was, so we were allowed to use 3 mL syringes on PICC and central lines. That's not the case at my current job though, so make sure to check with your pharmacy or nurse educator.

turnforthenurse, MSN, NP · Dec 7, 2012

What do your Google searches have to say about PICC insertion sites and size of syringe used with PICCs? I'm not sure what is being asked in your 3rd question.

The OP is referring to why a 10cc syringe needs to be used with PICC lines.

The need to use a 10cc syringe relates to the amount of pressure it provides with flushing the PICC line. Using anything less than 10cc syringe can damage the line.

brillohead, ADN, RN · Dec 7, 2012

The OP is referring to why a 10cc syringe needs to be used with PICC lines.
The need to use a 10cc syringe relates to the amount of pressure it provides with flushing the PICC line. Using anything less than 10cc syringe can damage the line.

Actually, the third question was:

3. How can you tell the difference between open-ended and close-ended?

MunoRN, RN · Dec 7, 2012

Open ended and non-open ended aren't actually the same thing as valved vs non-valved. Valved catheters such as SOLO PICCs are valved. Open ended refers to Power PICCS where the opening of lumen is sort of life the end of a straw. Groshong lumens are not open ended, they have a closed end and a slit on the side, the slit opens due to positive or negative pressure in the lumen. Because of this groshongs cant take the same pressure and flow rate as an open ended (Power) lumen.

So long as a lumen is fully patent you're not any more likely to damage a line with less than a 10ml syringe. You should always check patency with a 10ml (or a syringe with less volume but with a syringe that has a similar surface area to a standard 10ml syringe), although even then people seem to forget that you can produce the same pressure with a 10ml syringe, it's just the ratio of PSI on the plunger to PSI in the syringe is less.

In order for greater pressure to be created there needs to be sufficient resistance to the pressure escaping the lumen. If the pressure is able to freely escape the lumen then a 10ml syringe won't create any more intraluminal pressure than a 3ml syringe so long as you aren't excessively "slamming" the plunger. Our policy is to check for patency with a 10ml, but then whatever size needed to ensure the proper dose is given. (don't try and measure .3 ml in a 10ml syringe)