PICC line flushing question

[CrazyFLBean]

So I just because IV certified but I never practiced on a PICC line before. I had a few questions. When the order calls for you to flush the PICC line, do you aspirate to see if you get blood return or are you flushing it just flush it to keep the line open? Any tips on what to avoid or look for? I know learning things on the floor is so much different than in a classroom setting. I am not afraid to ask for help so have no fear, I just wanted to clarify on here.

[Deb123j]

Good question. I'm a new nurse and was never taught to aspirate first...just flush to maintain patency. I hate it when they clot off or they are able to be flushed but you can't draw labs off of them due to no blood return when you aspirate.

[GrumpyRN63, ADN, RN]

I always check for blood return, first it confirms its in the vein, second, if no blood return, someone should see if it is still in the correct place and if so, altepase can be ordered to try and restore blood return so you can use it to draw labs

[Deb123j]

I always check for blood return, first it confirms its in the vein, second, if no blood return, someone should see if it is still in the correct place and if so, altepase can be ordered to try and restore blood return so you can use it to draw labs

So if you don't get blood return...do you still use it for meds? The nurses I have worked with don't seem to mind too much if you can't get blood out of it, other than you can't do labs.

[VascRn]

Im certified and validated yearly to place PICC's. According to INS, infusion nursing Society, Picc lines should be flushed prior to using to maintain patency as well clear the lines from any medication that could be in the catheter. You aspirate for a blood return, helps one establish patentcy then using the SAS method, Saline-administer-saline, you flush the line administer the med then flush again. If a line is becoming occluded you may be able to push saline or meds into the line but you may not have a blood return. Depending on your hospitals policy and INS a PICC line can be declotted by a nurse that has shown competency and has been validated to do so. All PICC lines must be flushed with a syringe no smaller than a 10cc, to prevent rupture of the line due to the presure a small syringe exerts and using a push stop push stop technique to clear the line.

hope this helps :):redbeathe:bowingpur

[VascRn]

yes you can but eventually it;; clot off. sometimes, pending the type of PICC, ie groshong-valved ended or a power piic-open ended compatiable with ct's

[JRD2002]

I usually don't aspirate blood unless I am drawing labs. I think most lines are clot because someone has drawn blood from the PICC and not adequately flushed afterwards. I would not aspirate blood regularly because you are just increasing the chances that the line will clot. Anytime you aspirate blood from a PICC you should flush it with 20 mLs of saline. At least once a shift my facility requires that a nurse examine the PICC placement and document it. I think anything more than a 2-3 cm difference from what is expected and the PICC gets x-rayed to check for placement.

[labrador4122, RN]

In my facility after PICC lines are placed we call the MD to look at the xray for placement, then he gives the order for okay to use the line. Then we are never allowed to draw labs from there!

when we give meds, we use the SASH method. saline adminiser-med, saline then heparin.

i work with children, perhaps that is why we do not draw labs from that line

[JRD2002]

I am curious to know why you aren't allowed to draw from PICC's for labs when dealing with peds. Maybe it is because of all of the blood that you have to waste before you actually collect a lab specimen. Maybe it adds up to too great a loss for a little kiddo. I remember when I had a clinical in the NICU the nurses would waste a little bit of blood and then when their labs were drawn they would infuse the waste back through the line so that the neonate only lost the amount of blood required by the labs.

[NotReady4PrimeTime, RN]

If it's decided that a kid needs long term IV therapy and they place a PICC, they want to make darned sure the line will be useable for the time it's needed. PICC placement in kids isn't usually a bedside procedure outside the ICU, the kid goes to the OR. So there are many reasons why blood draws might be discouraged. The issue of the amount of waste blood is a factor in many peds illnesses too. In our unit we try not to use the PICC for blood draws if we have an alternative, or if we have a double lumen line we might use the large lumen for blood draws and the small lumen for infusions. Our transplant and oncology kiddies will have long term tunneled central lines placed because they have to be used for blood draws and the kids will go home with them.

[vascrn1]

Picc lines dont routinely need Heparin, especially with the rise in HIPa, a post xray confirms placment of the tip, ideally in the upper 1/3 of the SVC, as for care, as long as after every use and routinely the lines should be flushed with 10 cc's of NS, sometimes a fibrin sheath can attach at the distal portion of the PICC. With good care a PICC can last at least a yr. If TPN or hyperal, then one port should be designated for that and the other port to be used for labs and meds, again it is IMPORTANT to flush after each usage, second the manufacuture recommends using positive pressure caps, eliminates the use of HEparin, as my hospital no Heparin is used in the PICC's.

[Megsd, BSN, RN]

At my hospital we need a doctor's order to draw labs from PICCs, so we don't routinely aspirate blood from them. Just flush to maintain patency.