Picc Line Flushing

[arms]

Can anyone tell me the most recommended way to flush a PICC line? Do we have to use a 10 cc syringe or the smallest possible like a 1 cc tuberculin syringe. As what was recommended by our Interventional Radiologist to flush the PICC line with the smallest syringe specifically 1cc or 3 cc syringe with normal saline. But it's contradicting with what is normally read in written notes about care of PICC line, to flush using a 10 cc syringe. I've noticed too that PICC line easily clots. Do we have to flush them with heparin every time when not in use too? Does anybody has any idea?

[evilolive, BSN, RN]

My facility instructs us to flush with 10cc saline and 1cc heparin Q8 hrs. We document on this in our MAR. I always double check my order, as some MDs will order without the heparin based on the Pt's current issues/past medical history. I still flush with 10cc saline before med admin, and 10cc saline/1cc heparin following med admin based on flush orders.

[frizzness]

My facility wants me to flush with 5mls of NS then 3mls of heparin. Then the next time I hang antibiotics do I draw out the heparin or push it through with another NS flush. 4 ATX a day would make 120 mls of Heparin a day.

Last time the same Pt had a PICC and we flushed it with heparin, he hit his leg on a hoyer and got a huge hematoma and had to have a skin graft... I think we should be pulling the heparin out each time we start a new bag of ATX

[IVRUS, BSN, RN]

frizzness said:

My facility wants me to flush with 5mls of NS then 3mls of heparin. Then the next time I hang antibiotics do I draw out the heparin or push it through with another NS flush. 4 ATX a day would make 120 mls of Heparin a day.

Last time the same Pt had a PICC and we flushed it with heparin, he hit his leg on a hoyer and got a huge hematoma and had to have a skin graft... I think we should be pulling the heparin out each time we start a new bag of ATX

4 times a day of the final heparin flush is 12 cc total for the day... And what is the concentration of the Heparin flush? It should be the lowest concentration, so 10 unit per ml would be 120 UNITS of diluted heparin flush daily. This WILL not interfere with coagulation in your patient. If your patient developed a hematoma s/p injury, you can blame it on the fragility of the venous/capillary system of the patient, especially if he is older. Also what medications like coumadin or even a ASA a day can interfere with coag times. No need to draw out the heparin flush before flushing. Now, if it's a dialysis catheter that a DIALYSIS nurse is flushing, then yes, they withdraw as the concentration is MUCH greater.