PICC Line Clarification

[Kenneth Oja, PhD, RN]

Depends on the brand / manufacturer. PICC lines might have one, two, or three lumens. Typically, with a triple lumen PICC, the proximal port is white, medial is blue, and brown is distal.  

Although it may appear to be one line, since they are all enclosed in one sheath, each lumen (line) allows for separate infusions. So, no, medications going through different ports will not mix within the line. 

Each line also typically has a different exit port so not all infusions come out at the very tip of the PICC. This is to further reduce the risk of mixing.  

I would check the information from the manufacturer to confirm for the specific type of PICC you're using at your facility.

[nurseprnRN, BSN, RN]

They aren't cut to length, they are inserted to the right place in the ra and the extra of whatever length is outside the skin.

If your picc has more than one port (nowadays, most do) then they should be labeled distal/prox/med/whatever. the lumens are separate. see if you can get one from the sales rep to use as a demo and play with-- ask your central supply manager to ask for one for you. that will help.

[carolmaccas66, BSN, RN]

What is an EHR? What does TLC stand for? Sorry can people PLEASE put the full word at first, then the abbreviation in brackets. OP you are shooting yourself in the foot as we can't understand what your abbreviations are and therefore you may lose out on valuable answers. People from other countries may have different ways of saying things too.

I don't know why u think we would need to cut the tip or the port? What rationale did you have in mind for that - just interested in your thinking process. The PICC line needs to stay intact as medications go right into the patients superior vena cava, to their heart & circulatory system. They can thread PICCs thru any large vein if necessary though.

All PICC lines I have used have multiple ports that are usually coloured. Red could be to draw blood, blue for IV medications, another port, ie: white, could be used for chemotherapy. These can be labelled, but usually aren't. PICCs can be used for nutritional reasons too and are very versatile.

What do you mean all meds come out the tip of the PICC? I for one am a bit confused by your questions.

Maintain strict cleanliness with PICC lines as the patient can pick up infections very easily from dirty hands and unsterile techniques. Can't tell you the amount of times I've seen peopel inject into a PICC without swabbing it first with alcohol.

I am confused by the way you have written some of your questions so hope the above helps a bit.

[KelRN215, BSN, RN]

If you have a double lumen PICC it's just that- two separate lumens. We have patients with double lumens all the time who are getting PN/lipids (they are separate in my facility) and also on a bunch of IV meds which are incompatible with them which is great because then you can give all things at once.

As far as documentation goes, in our electronic system under PICC you select if it is a single or double lumen and then it asks for a description of each lumen. Since each lumen is usually a different color, that's usually how it's marked. "Lumen 1 description- red lumen. Lumen 2 description- white lumen." etc.

[AgentBeast, BSN, RN]

EHR= Electronic Health Record

TLC= Tripple Lumen Catheter

[IVRUS, BSN, RN]

JayMal,

Since PICC's can have one, two or three lumens, and each one could be a different color at the hub/innjection cap connection, I would allow a blank spot for this info, and let's say that it was a triple lumen with a purple, red and white port, have them "click" on triple lumen and then that would bring down another section in which they could designate each color and the flushing protocals would follow. (That is if your system can do that). Each lumen on a PICC line is SEPERATE and needs to be treated seperatly. They DO NOT merge into a single lumen.

[IVRUS, BSN, RN]

Yes,

Since the lumens may not be labeled like a TL Arrow Catheter, color identification will work. But to answer your question about the cutting of a PICC, yes, sometimes open ended, non-valved PICC's are cut before insertion.

[Esme12, ASN, BSN, RN]

I think some PICC catheters are cut to length which is why they must be measured on removal...I am familiar with the broviac

PICC lines commonly are available in sizes from 2 French to 7 French (3 French = 1 mm). A special plastic IV catheter, which can be split apart and which is large enough to admit the PICC line itself, is placed into a vein. The PICC line is trimmed to a length that will allow the tip to lie near, but not in the heart. The PICC catheter is then placed through the IV which is already in the vein and advanced until the tip is near the heart. The initial IV is then split apart leaving the PICC line alone remaining in the vein. PICC lines should be cleansed and dressed. They are good at allowing administration of home antibiotics or nutrition by vein (parenteral nutrition) because of the stability of the access combined with safety.

And the "proximal,distal" on open ended double lumens are cut prior to insertion the ports a re "proximal,distal" indicating 2 ports not necessarily true position like the TLC, multilumen caths

[psu_213, BSN, RN]

Out of curiosity, how many facilities' EHRs require documentation of which port is which on a PICC (i.e. distal, proximal, etc.)? Our's does not. Also, I believe all our our PICCs are consitent when it comes to color coding (for example, red is always distal and purple is proximal...or vice versa ). Eitherway, the ports say 'proximal', 'distal', etc right on them...on our's anyway. Specifically charting which is which seems like overkill. That being said, it is a good idea to chart if one of the ports is dedicating to some medication, etc. For instance, charting that the red port is for TPN.

Another issue...what if they had the PICC on admission (e.g. using it for outpt. antibiotics) and is was not labeled as to which port is which?

[MunoRN, RN]

Power PICC's don't have proximal and distal exit points. A double lumen Power PICC is open ended and consists of a single lumen divided in two by a wall, they exit through an open end with the exit points for each lumen next to each other, so neither the red or purple port is proximal or distal. Side exit ports such as a groshong do have proximal and distal exit points. A triple lumen Power PICC is 1 Power (open ended) lumen and 2 groshong lumens.

[JayMal]

Thank you all for your help. I did not think they were cut, I heard it in passing. Pretty much it comes down to patient safety and labeling a triple lumen, or PICC is safer when marked by color then by medial distal proximal, since that type of labeling is more standard.

[**LaurelRN, MSN]

ok- so here's the low down....

some picc lines are cut to the length for the specific patients- thought not all. here's are clue...if it is a power picc (mostly used in acute care) they are not cut. if it is not a power picc (and they will say right on the picc if it is) then it could be cut. it depends on the manufacturer. when a patient comes to your facility with a picc line- it should say on it how far in it is. most uncut picc's are 45-55 cm- and will have some of the catheter looped under the dressing. if it is something less less 45cm and nothing is hanging out- it is one that is cut.

as for the lumens- there are 1,2,3 and soon to be 4 lumen picc lines. every lumen has it's own hole that it comes out of (distal,proximal, etc) which is why they can be used with drugs that are incompatible.

hope that helps! ?