Picc line care/flushing

Twinmom06, ASN, APN · Apr 26, 2016

why was there heparin in the PICC line? I thought EBP got rid of locking with heparin eons ago. The only central lines I ever see locked with heparin are the dialysis catheters.

Altra, BSN, RN · Apr 26, 2016

Not sure I'm correctly understanding what you are describing.

I haven't seen peripheral or central lines flushed with heparin in the last 10 years (except HD caths, as noted in the post above). We draw and discard a 5mL-ish waste before obtaining lab specimens, but not before flusing.

What interventions were being done? Med administration? Obtaining labs? Discontinuing an infusion?

FloatRN19 · Apr 26, 2016

Sounds like the nurse was cath-floing their picc.

Ellie G · Apr 30, 2016

Haven't seen heparin in a picc line. Just dialysis catheters and ports

MsPebbles · Apr 30, 2016

I'm confused too. I only waste blood if I'm drawing labs.

MXRobRN · Apr 30, 2016

There certainly are still central lines being used nowadays that still require heparin flushes. Non-solo power PICCs without anti-reflux valves, tunneled PICCs, ports, and IJ's (not really dialysis caths, they use sodium citrate I believe) are some of the lines we have to heparinize. Institution policies vary of course, but that wasn't the TC's question.

I have seen RN's pull back to waste heparin in the line before accessing it. I do it occasionally myself, especially if the line is being declotted with alteplase. Correct me if I'm wrong, but I don't believe there's much evidence either way on whether or not it results in lessening the risk of a hemorrhagic event for the patient. However it's good practice to always ask yourself a few questions before accessing a line that requires heparin. Have there platelets been downtrending (could indicate HIT) or are they thrombocytopenic? How is their H&H? I wouldn't waste much blood (if any) if very anemic. How often are the flushes being performed? You would not necessarily want to heparinize a line that's being accessed excessively for abx, etc. Could this line run normal saline at KVO if that's the case?

If someone else was able to find evidence either way that would be great! But as it stands for me it is a nursing judgement thing. You really don't need to waste much blood to clear the line of heparin anyway, 1-2cc would ensure most all of its cleared.

Libby1987 · Apr 30, 2016

Just FYI, those who aren't seeing heparin in PICCs? You're sending home occluded PICCs pretty frequently. Just had another one this week. First day home and it's occluded. "Oh the nurses said it didn't need heparin.."

I think it's pretty easy when you have all the resources at hand. Not so much for the rural immobile sick patients.

Infusion companies dispense heparin with orders to flush 1-2 x daily for a reason.

IVRUS, BSN, RN · May 2, 2016

There are plenty of organizations who are still using Heparin Flush as their locking agent in NON-Valved IV catheter to prevent occlusion/fibrin buildup. And yes, many have gone to Saline "locking" only, and some have seen a dramatic rise in catheter occlusions. So, really develop and follow your agencies policies. The company I work for still utilizes Heparin Flush, but we stay with the lowest concentration available of 10 units/ml for all central lines that need it, and if there is a concern that the patient has HIT, then all source of Heparin are discontinued.

In addition, what the OP described is ridiculous. When flushing a line that does not have inotropic medications or narcotics infusing into them, there is only a need to verify a blood return, but NOT withdraw 5 mls and discard it. Get a good blood return then flush it back into the patient.