PICC line cap change question!

[sweetieann]

Our facility uses those positive pressure patency caps, where you don't clamp them when the line is not in use. However, I have a question. When you change the caps on these, you'd obviously clamp the line to prevent air embolus, correct? (b/c you're changing the positive pressure cap, so if you take that off, there is no "positive pressure" between cap changes, since the cap is what causes this positive pressue). Am I correct?

Thanks! I don't have alot of experience with these...

[Wise Woman RN]

Yes, clamp with cap changes. I usually hook them up to a 10 ml flush, prime them a little bit, then attach and flush.

[sweetieann]

what if it is the type of picc with no clamp on it at all (i have heard of these)? it's ok to change the cap on these with no clamp???

[Wise Woman RN]

We only have the ones with the clamps, but we don't leave the tube clamped all the time, just when we change the caps. I haven't seen the other kind, but would do some research before removing the cap for any reason.

[bsrn0523]

we occasionally get single and double lumen piccs with no clamps. i still clamp off the lumen next to the cap prior to changing the caps.

[SWEnfermera]

There are several PICC catheters on the market that have one-way valves built into the catheters. The catheters I have seen used most often are from Boston Scientific. They are called PASV (Pressure Activated Safety Valve) catheters. The manufacturer recommends against clamping these catheters when changing the caps. I have included the link to Boston Scientific and their recommendations for care, flushing, etc of PICCs. Never use smaller than a 10cc syringe (this exerts too much pressure on the catheter) and use a pulsatile (start/stop) technique.

Your hospital should have a policy/protocol on the care of central lines. If you follow the written policy, you can't go wrong.

Usually, the dresing on PICCS is changed 24 hours after insertion and then Q7 days and prn. Caps are usually changed Q72 hours and prn.

http://www2.bostonscientific.com/templatedata/imports/HTML/infusion_therapy/proc_cathcare_01_s4_us.html

[czyja, MSN, RN]

If the line is not clamped and the clamp is removed then wouldn't blood flow out?

[iluvivt, BSN, RN]

Caps on all CVCs (this includes PICCS) should be changed at a minimum at least every 7 days. Some facilities change them sooner but most protocols I have seen are now q 7 days. Here is how you can tell what to do with any PICC or CVC for that matter. If the clamp is an integral part of the design of the catheter ( meaning it came with the clamp(s) out of the package) then you must clamp it when changing the caps otherwise you risk air embolus.

here are the steps after hand hygiene:

1 Prepare 5 -10 ml normal saline and lock that onto your cap in an aseptic manner

2 assess for type of PICC and if there are clamps..... clamp them now

3 disconnect your cap and aseptically apply new cap and unclamp and flush using a pulsatile push pause method. If you have a positive displacemnet cap or valve you must disconnect the flush syringe from the PICC or CVC first and then clamp or you defeat the purpose of the positive displacement valve. You DO NOTwant to flush,clamp and disconnect

There are many types of PICCs on the market and if a PICC has a valve as part of its design you will not see a clamp nor should you use one,especially on silicone catheters like the Groshong.

There is a little spring in the positive displacment valve and when you disconnect the syringe it springs back and forces blood out of the tip of the catheter thus minimizing occlusion and infection risk

[sweetieann]

ulivivt~THANKS SO MUCH! I finally understand now. This is exactly what I needed to know.

Thanks everyone, actually, for your responses :)

[elizabells, BSN, RN]

We use umbilical lines without clamps, which look a little like a PICC. What we do when changing the hubs is wrap a 2x2 gauze around the catheter itself and use a (non-toothed!) hemostat to clamp the line. Our lines go down to 3Fr and I've never had a problem with a damaged line doing it this way. I'm sure it's probably wrong, since it's a workaround solution, but as I said, I've never had an issue.

[SaraO'Hara]

I would clamp it - I tend to use the snap clamp on saline locks too... just because one time the patient presented me with a positive pressure cap that had come unscrewed, leaving the lock totally open, but for that I had clamped it.

[iluvivt, BSN, RN]

It is OK to change the caps on the UAC or UVC as described as long as the clamp is smooth as you have stated. I am certain that it requires a significantly smaller volume of air in these infants and premies to cause a problem and even death The UAC and UVC lines are considered short term lines and b/c of that probably will not have the # of cap changes that a PICC or CVC will. We have a pt now that has had a PICC in for a year without infection or any other problems for that matter but the longest we have maintained one was for 4 years.