PICC line trouble

glb1960 · Jun 7, 2006

Could be several issues. Could be clogging with meds. Docs can order dissolvers that can clean the line. More likely is a fibren clot on the PICC tip. TPA can help dissolve that . Heparin prevents clotting but doesn't disolve a formed clot. Could have become positional. Try having the pt. raise arms above their head, across their chest, elbow bent/straight, lie on L/R sides or back, sit up or take a deep breath and hold it while you try to draw the line.

Good luck, Gary

Home Health Columnist / Guide · Jun 7, 2006

Flush well with minimum 10 cc saline prior to above arm movements.

What size syringe are you using for blood draws too? Should be 10cc

I don't use vacutainer on this type of line either.

Slowly pulling back sometimes helps too.

My guess is fibrin sheath development too. Can get sister to use extra NSS --makes sure all drug out of line then heparin.

If still issue, notify ordering doc next visit.

Daytonite, BSN, RN · Jun 7, 2006

If repositioning the patients arm a number of different ways doesn't help, it's most likely that a fibrin sheath has formed a flap that is working like a one-way valve over the distal opening. If that is the case, the only thing that will resolve this is to treat the line with one of the clot busters. From then on the line should be flushed with 20cc, 30cc or more of saline after all meds and blood draws to keep the line patent.

Larry77, RN · Jun 7, 2006

ugh...I have an issue with some family using PICC's at home. They may say they are doing things like flushing with NS and Heparin but who knows. What about those times they are in a hurry and think it's no big deal to "skip it this time". But then again even with perfect technique PICC's don't last forever...oh how I love those chestports :)

Jo Dirt · Jun 8, 2006

The line has two ports and where I was able to get enough blood to test yesterday today nothing would come out of either port.

The guy's sister acted like she didn't want me to stick him but after an hour and a half of working with this PICC line I told her we had to. She is very protective of her brother and very involved in his care, which is a good thing, but can make it hard for the health care providers.

He had a beautiful vein pop right up on his left forearm and the stick was easy as can be.

I tried to call the doc's office to see about getting some meds to clear the line but he was closed today. I will try tomorrow. I certainly appreciate the help.

wooh, BSN, RN · Jun 8, 2006

Always try changing the dressing before doing anything else. There could be just enough of a kink under the dressing that it will flush, but you can't pull back on it.

LCRN · Jun 8, 2006

The line has two ports and where I was able to get enough blood to test yesterday today nothing would come out of either port.
The guy's sister acted like she didn't want me to stick him but after an hour and a half of working with this PICC line I told her we had to. She is very protective of her brother and very involved in his care, which is a good thing, but can make it hard for the health care providers.
He had a beautiful vein pop right up on his left forearm and the stick was easy as can be.
I tried to call the doc's office to see about getting some meds to clear the line but he was closed today. I will try tomorrow. I certainly appreciate the help.

I had a PICC line when I had to receive Vanco for osteomyelitis for 6 weeks. My homecare RN also had a lot of difficulty drawing blood from my picc. I routinely flushed with additional saline and hep saline. I ended up having to always hold my arm above my head and take deep breaths and cough to get an intermittent blood flow. I received alteplase 2cc in each port which did not help (picc flushed easily just difficulty was in aspirating blood). It was decided it was just a very positional line...I was drawn peripherally for p/t's.

Does the Picc have claves? After each blood draw and dressing change they should be changed...they can cause a sluggish or no blood return at all. Sometimes these lines do not cooperate...

LCRN