PICC line flushes

[mkflorida]

Hello,

I am new to allnurses and to posting so accept apologies if this is posted wrong.

I am working on a policy regarding drawing blood from PICC lines and have found some conflict, so I thought I would ask the following:

This is the procedure that I have found:

- first withdraw 6 cc and discard

- then flush with 10 cc's n.s. (and this is the part that I don't understand why or if it is necessary- thoughts?)

- then draw labs

- then flush with 10 cc's (some say more -thoughts?)

- then heparinize

Any advice on the above? most appreciated.

[PICC ACE]

Flush first to establish patency. Then draw up the waste. Then draw up the lab samples. Then flush again. Heparinize if needed,but not all catheters or systems need Heparin.

The usual flush amount is 10ml for the average PICC. Generally I see people do a 20ml flush down a line that has TPN running through it. Catheter size is a factor as well. A 3Fr cath has less 'dead space' or 'luminal volume' and you may only need 3ml for a thorough flush.

Most manufacturers have instructions that give the flushing recommendations.

Regards,

L'As de Piques

[DutchgirlRN, ASN, RN]

Our protocol is:

Must have a doctors order to draw blood from PICC line

for labs.

Establish patency of line

Aspirate 10cc from PICC line. Discard

Aspirate 10-20 cc for labs

Flush with 10cc normal saline

[mkflorida]

thanks for all you help!

I really appreciate it!

[ginger58, ASN, RN]

The usual flush amount is 10ml for the average PICC. Generally I see people do a 20ml flush down a line that has TPN running through it. A 3Fr cath has less 'dead space' or 'luminal volume' and you may only need 3ml for a thorough flush.

To access a PICC we flush with 10 mL of NS and to exit 20 mL. We aren't allowed to enter a line with TPN in it unless it's a single lumen but if someone needed TPN they would put in a double lumen.

We have found that 10 mL with the push-pause technique reduces the need to Cathflo. Even though you only flush with 3 mL we don't use any syringe smaller than a 10 mL.

[Night Light]

My hospital system differentiates between adult and pediatric picc lines, because they are different sizes, and therefore, different volumes to aspirate and flush with. But don't flush immediately before drawing labs....that would mess the labs up, establish patency, ya know, flush it with saline, and aspirate your waste, then draw labs, then flush with NS, then with Heparin. The manufacturer of the PICC lines, get a peds picc line information insert, and an adult picc line insert, then go from there, as to volumes you need to waste ahead of time, before you establish your policy. Obviously, when giving a medication, you don't need to aspirate a waste first, so you'de be skipping that step.

[Night Light]

I just read PICC ACE's reply. Listen to that one. It's correct that not all PICC lines need Heparin....so like I had said previously, that's why it's important to read the manufacturer's insert, as to which kind of PICC lines you are dealing with, and make the differentiations in your policy.

[Patti 2nd gen RN]

My facility also has a policy that you syringes must be more than 3cc as 3cc has too much pressure behind it--we always use 10cc or larger. We also, as a sub-acute unit, use PICCs for a long time, and find ( just by experience--don't have studies) that they seem to last less time if we draw blood from the ones that can be inserted at the bedside--they get sluggish faster, and we need to use cath-flo more often if we use them regularly to draw blood from---but the larger ones inserted at hospitals that do them under floroscopy don't have these issues.

[bbsport7]

I am looking for information on PICC lab draws, specifically if used for coagulation studies if Heparin is running....

[ginger58, ASN, RN]

I am looking for information on PICC lab draws, specifically if used for coagulation studies if Heparin is running....

Our policy is to do a venous stick.