PICC line flushing question

I would check your employer's protocol. I learned to aspirate (as you describe above) in nursing school, but at work we do not aspirate.

Yes, it is imperative that all central lines yeild a brisk, free flowing blood return. You should assess for this each time a medication is given. Not assessing is negligent and leads to bacterial contamination and thrombosis. Catheters which are centrally placed and can be flushed with ease, are still non-functioning catheters if they aren't letting you get a blood return with gentle aspiration.

if you do not aspirate all you know is that the fluid goes in one direction only.

i do try and aspirate but not all will .i work ED so we can still use PICC even if blood does not aspirate

Depends on your facility policy if you are required to or not.

That being said, you really should check for blood return anytime you flush with saline. It is very important to make sure that the line is both flushing and able to draw blood. Nothing more annoying then coming in at 05:00 to draw AM labs and finding your PICC (which may flush great) won't draw blood anymore.

we only aspirate power ports. The standard single lumen, no.

But not aspirating a brisk, free flowing blood return may mean that the tip is covered with Fibrin. That fibrin is a precurser to Bacterial contamination and Thrombus. Not getting a blood return is serious, and If your patient develops problems and it goes into a court of law, your documentation which neglects to reflect that you had a brisk blood return will be problematic as it is STANDARD of practice to get a blood return from all central catheters.. Single, double and so forth.

Our PICC team says that the reason that we don't want to aspirate a single lumen PICC that flushes but does not have blood return is to NOT dislodge the clot that may be at the end of the tip. We defer to them. I'll have to go back look at the policy. We have a whole protocol to avoid CL infections.

If they have fluids running continuously, I still aspirate at least once per shift. I need to fully know what I am working with.

I guess it's not a huge deal if you're not planning on drawing blood from it ever.....but why not? It takes 3 seconds

But not aspirating a brisk, free flowing blood return may mean that the tip is covered with Fibrin. That fibrin is a precurser to Bacterial contamination and Thrombus. Not getting a blood return is serious, and If your patient develops problems and it goes into a court of law, your documentation which neglects to reflect that you had a brisk blood return will be problematic as it is STANDARD of practice to get a blood return from all central catheters.. Single, double and so forth.

It's not actually a legal standard of care. We confuse these definitions by using the term "standard of care" for things we'd like to be a standard of care (practice recommendations, etc), but that doesn't actually make it a legal standard of care which is much different. A legal of standard of care is one where you would find universal agreement and compliance, where failure to follow that is so rare and out of the normal practice that it is legally considered negligent. As you can see from the previous posts, aspirating for blood return with every medication is by no means practiced at the level that would constitute a legal standard of care.

There is still ongoing debate and variations in practice that prevent this from being a legal standard of care, and personally I'm agreement with the side that says there isn't any significant effects that frequent aspiration increases the risks (line occlusion, biofilm growth, etc), but it's not a settled issue.