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.

[diveRN]

PICCs that flush but don't draw can still be used for meds. Generally what causes this is that a "fibrin tail" forms at the port's distal end. When you aspirate and get no return, the tail can get sucked back into the cath and occlude it, something of a one way valve.

Our hospital still uses heparin locks, but is actively researching the possibility of using straight saline due to the possibility of HIT. Even though the heparin lock flushes are very low dose heparin, cases of them causing HIT have been documented and I've personally seen two. Pts would develop HIT when no other heparin products had been given over the course of a hospital stay.

Question is, if you use a heparin flush to lock, are you aspirating the heparin from the line before your first SASH flush or are you just pushing the heparin into the patient?

[travelbug97]

I have been specialized in PiCC nursing for over 12 years, and it varies from hospital to hospital. Try to find what your hospitals policies and procedures may be, and if they don't have it, you may have to inquire about that.

As per CINA and INS standards, you need to have blood aspirate before you start any medication or blood draw. In order for you to check patency, and if your getting blood then your in the proper place. All patients with piccs should have a database of how long there picc line is, some may actually have a midline--and if thats the case, not all midline catheters aspirate blood. Do a little research. Its unsafe in my opinion to keep injection meds thru the picc line that should be in the SVC, *standard PiCC line placement* and that has no blood aspirate..You often wonder if its in the right place, and if theres a sheath around the catheter, and you dont want to cause an embolus.

As well, Groshong PiCCs need to be flushed daily usually when not in use. Most institutions require TPA by reverse aspiration technique to avoid pushing the tpA thru the catheter. Investigate what meds this patient is receiving. There are plenty of solvents to clear obstructed picc lines as well, depending on the pH of the medication used. If you require more info, call your INS chapter and or Vascular Access Team if your institution has it. or you can email and I ll direct you to the appropriate resource:)

Remember, don't always do what your told. Always investigate, the rationale in preforming a nursing intervention. Your patient's life is on the line, and your license.

Use best practice always.