PICC lines

[NurseQT]

When administering a med through a PICC (one that's used only once a day) do you draw back blood before flushing the line?

[firstinfamily, RN]

Yes, I did this every time before administering a medication and the rationale was to verify the line was in a vessel. The PICCs can migrate and it is important to verify you are giving the medication to a patent line as well as one that is in place. You should always have a cxr result available to verify the tip is in the SVC or large vessel. With blood draws we would use the initial blood return as the waste before drawing the blood specimen. Don't forget to change the blue clave tip with every blood draw. Often when no one was able to get blood from a PICC line it was just that the clave tip needed to be changed. We usually changed ours weekly or with lab blood draws.

[t&g0913]

No, not for just administering a med

[iluvivt, BSN, RN]

You need do perform a complete assessment your PICC line or any CVC the patient may have.Part of that assessment is to verify that you have an adequate blood return and that it flushes easily consistent with the size of the lumen. A blood return does not verify tip placement.It only verifies it is in a vessel and that you have a fully patent line. If you are able to easily instill but can not withdraw blood you have a persistent withdrawal occlusion (PWO).A PWO must be treated with TPA. It is usually caused my a fibrin tail or sleeve. There is a correlation between thrombotic occlusion and increased rates of infection and that is why it must be treated even though you can still instill.Also verify that you have a confirmed tip placement and that there is no significant change in the amount externally viable ( 2 cm or more)..Many PICCS can now have a confirmed tip placement by the use of ECG technology if certain criteria are met and that will documented by the PICC nurse.Also make certain you are documenting a blood return on your PICC or CVC at least once per shift/prn or per your policy.

[SierraBravo]

I agree with the above posts, even though you are only using the line once a day, it should be flushed and assessed for patency q8h or once a shift. In our facility we don't change out the clave with every bood draw or else we would be changing it at least once a day. We change our claves and lines twice a week. Changing the clave with every blood draw seems excessive since most patients get labs every day, if not more often. However, if I notice a clave has some blood in it I will change it early. Although, in home care they only flush the line once a day, so it's best to check with your facility policy and procedure manual. I'd be surprised if the policy wasn't to flush it q8h.