PICC: aspirate blood before every infusion?

[mlolsonny]

Big discussion at nursing home. Single lumen PICC. Educator says aspirate for blood prior to every flush and infusion. A couple of us think that's asking for trouble. What is best practice in home care or outpatient setting?

We're measuring exposed length and arm circumference daily. Aspirate for blood or not?

[IVRUS, BSN, RN]

So, let's say that you are giving an IVAB. Med is due at 0600. At 0555, you do all your checks on the IV catheter/drsg, you check the saline syringe, and you do a good, vigorous scrub of the needleless connector. You hook up your saline syringe, flush about two mLs, then slowly aspirate for a brisk blood return, the color and consistency of whole blood, then flush with the remaining 8 cc saline (if your policy is 10mL flush a and p) disconnect the saline syringe and scrub again vigorously with alcohol pad.  Then administer the IV antibiotic over the needed time frame, stop when BAG IS EMPTY, then disconnect.  Scrub connector again, then saline flush and Heparinize if needed, depending on the IV catheter.  The only time to assess is blood return is at 0555. NOT at 0555, 0630, 0635 when the second saline is flushed. 

[Dohboy]

Yes, aspirate for blood before daily infusions per institutional policy and then flush with remaining saline as mentioned above. This is a way of confirming that the tip is still in the desired location and hasn't migrated. Also a way to make sure the line doesn't have a fibrin sheath forming on the end of the PICC line. And remember to apply Curos caps to any y-ports on infusion lines and apply a Curo cap to PICC catheter after disconnecting IV line.

[IVRUS, BSN, RN]

A curos cap is a good idea, but if it is not your policy to use them, then scrub, scrub , scrub that needleless connector each and every time before you enter it. 

[Dohboy]

Curos caps should be standard across the board for all piccs by now, they are inexpensive and effective. At no point do they replace the practice of scrubbing the hub.

[mlolsonny]

Scrubbing the hub was never in question. Pulling blood through the lumen of the PICC was. This was not how most of our RNs were taught, so we were asking for expert opinions. 

Thanks for your responses.

[0.9%NormalSarah, BSN, RN]

I always pull back on my PICC lumen before administering a med to make sure the end of the lumen isn’t forming a fibrin sheath as someone else pointed out. Sometimes I don’t get blood return right away until I flush it, then I get blood return. It doesn’t mean the PICC can’t be used, but it does mean a further assessment is required. Typically we cath flo those that don’t get blood return, and a CXR would confirm continued appropriate placement. However I’m not sure what you would do in the LTC or OP setting for that, in the ICU I can easily troubleshoot the issue.

[MunoRN, RN]

On 7/22/2021 at 6:34 AM, IVRUS said:

So, let's say that you are giving an IVAB. Med is due at 0600. At 0555, you do all your checks on the IV catheter/drsg, you check the saline syringe, and you do a good, vigorous scrub of the needleless connector. You hook up your saline syringe, flush about two mLs, then slowly aspirate for a brisk blood return, the color and consistency of whole blood, then flush with the remaining 8 cc saline (if your policy is 10mL flush a and p) disconnect the saline syringe and scrub again vigorously with alcohol pad.  Then administer the IV antibiotic over the needed time frame, stop when BAG IS EMPTY, then disconnect.  Scrub connector again, then saline flush and Heparinize if needed, depending on the IV catheter.  The only time to assess is blood return is at 0555. NOT at 0555, 0630, 0635 when the second saline is flushed. 

If your going to assess the blood for the "color and consistency of whole blood" then you're going to have to pull at least some of it back into the flush syringe, in which case you should be flushing after that with a flush that has no blood in it.

[MunoRN, RN]

A PICC should be regularly assessed for blood return, but the frequency that should occur is unrelated to how often or when infusions occur.

[sharris]

It is a SOP to check blood return on ALL central lines.

[IVRUS, BSN, RN]

YES, YES, AND YES! Each time, Every time!  Now, once you assess and have patency with NSS, then you don't need to assess it again if you are heparinizing the line after your saline flush, but a brisk, free-flowing blood return the color and consistency of whole blood is important.