PICC Lines

[b981]

I have a question about PICC Lines. If a line will not draw blood, is it okay to flush. This is what I've always been taught. I just started a new job and was going to flush the line. The LPN who was precepting me (I'm an RN and not a new nurse) told me to stop, I was going to kill the patient. I've been searching for days for the policy on this because the people at the facility backed this up. I'm not saying it's wrong, but I told him you should never tell someone they are going to kill the patient in front of the patient. The patient also told me the previous nurses had been flushing his line and hanging his antibiotics. I know that Alteplase has to be administered as I have done alteplased lines many times myself. I'm tired of these toxic people on nursing floors. I wish there were more non patient centered nursing jobs just because of toxic people on floors. I transferred from the same company in a different location. This place where I work now doesn't even put caps on PICC lines. The whole culture there blows my mind. Thoughts? Yes, I know that I need to look for a new job, but I am not taking a pay cut. I moved for this job and I'm not leaving until I'm ready to go.

[IVRUS, BSN, RN]

If I were YOU, I would have a "sit-down" with the Director and Staff Development person.

The organization I work for uses pre-filled Saline flushes and they are used by flushing approx. 2 cc of the ten ml syringe into the IV catheter, THEN check for a blood return that is the color and consistency of whole blood. If one does NOT get it, perform nursing interventions, such as having the patient turn their head and cough, or reposition the pt. BUT, it is mandatory that you obtain a free-flowing blood return.

You will not KILL a patient by flushing the catheter before checking for a blood return, and if you attempt to flush and meet resistance, STOP as the catheter is occluded somewhere, somehow.

Yes, Alteplase (Cathflo) should be the agent of choice to be used whenever you have a total occlusion, but also with a PWO... Paritial Withdraw Occlusion.

[la_chica_suerte85, BSN, RN]

No, they are going to kill patients with infections by not using caps on PICC lines. The worst you can do is cause the line to coil up like a fire hose if it busts from the pressure (which, might not be great if there are cardiac issues) and then they need a new line. That's bad but infection is a much more prevalent issue.

[IVRUS, BSN, RN]

If they are NOT Placing ANY cap on the end of the IV catheter, then yes, I would agree that that is really dangerous...and can be deadly, but I didn't take that from the OP. I was thinking that the OP meant that they were NOT using a SWAB OR CURUS alcohol impregnated cap on the end of the needleless connector.

They are optional caps, though I like the concept.