PICC Lines - To clamp or not.

[raskol]

I am at a new facility and had a few questions regarding PICC lines. I have consulted with my fellow nurses and looked at my policies, but still wanted some other opinions.

Where I am now, the lumens of the PICC (only single/double lumen, boo), have a t-port adapter on them. I am used to the clave adaptor like on a saline lock. Are these t-port type connectors considered positive pressure caps and does that mean I should not be clamping them?

The brief search I did on the research left me with conflicting information. Some said if it has a clamp on it, use it, and others said if it's positive pressure caps then do not use the clamps.

I am coming from a facility that was very stick about clamping and here the nurses don't at all "for fear of clotting." I was told, if I am flushing regularly, I don't need to clamp. That didn't sit right with me so I questioned and asked.

Thanks!

[KalipsoRed]

Uh, I'm no expert, but that sounds like poo to me too. As far as I know a T valve does not creat positive pressure and thus should still be clamped if it is not in use. It seems to me that if you DIDN'T clamp it you would have a greater risk of clots and cloggs to the line. If there is a positive pressure cap at the end of the t-valve then I guess you wouldn't have to clamp it. That's my clinical guess, but if they have a clinical educator there I'd make him/her explain that in greater detail to me.

[SprightlySparrow, BSN, RN]

I'm not entirely sure what kind of adaptor to which you are referring, but in my clinical practice I clamp all my central lines (PICCs included, of course). I have asked our PICC team RNs, and they have told me to clamp related to the risk of exsanguination should the clave inadvertently become disconnected. I flush the line as I'm clamping in hopes this will prevent clotting.

I have heard there is no need to clamp, of course, if you have a clave that creates positive pressure...but I have seen these claves become disconnected from the lumen so many times that I feel uncomfortable leaving them unclamped. In my own practice, I have actually had one come off and my patient bled into the bed. Luckily, I was standing right there and caught it in time so she did not have any negative outcome whatsoever, but after that incident I will never leave one unclamped again!

[Flo., BSN, RN]

The brand my hospital uses has a tag attached that says "do not clamp", so I don't.

[LouisVRN, RN]

My hospital also has a policy where the lines are never to be clamped, the only time I clamp is while I am changing the caps.

[JxMom]

From my experience it depends on the brand...I agree with Kalip ask your educator to further explain this information to you...

[~Mi Vida Loca~RN, ASN, RN]

We have two health care systems here and they each do it different. One system it's policy to clamp and the other you don't because of whatever type they have. They don't even have clamps on them.

[MunoRN, RN]

By "T-type connector" do you mean a something like a 3-way valve? Or a splitter? I don't know of any add-on devices other than caps that are positive pressure devices so I'm guessing it probably doesn't have a positive or neutral pressure valve.

SOLO PICC's have a built in valve and therefore don't come with a clamp. If you use a different type, such as a Power PICC, you do need to clamp using positive pressure clamping. Also, caps can come off when they shouldn't, like while a patient is sleeping, and if the line isn't clamped then you've got an open path for the patient to bleed out, as well as for air and bacteria to get in. If you use a positive pressure cap on a PICC (other than a SOLO), then it defeats the purpose of the cap to clamp while flushing, although clamping after flushing and removing the syringe doesn't hurt enough and adds a layer of safety if the cap should come off.

[MunoRN, RN]

LouisVRN said:

My hospital also has a policy where the lines are never to be clamped, the only time I clamp is while I am changing the caps.

What's your hospital's rationale for banning clamping?

[K+MgSO4, BSN]

By T port do you mean a light blue clave CLC 2000? Then don't clamp them.

[IVRUS, BSN, RN]

See attached file for a pic of the CLC2000. Is this what you're talking about? If so, the catheter or its extension set should not be clamped before the syringe is removed as the inner white piece is designed to Spring back in place, but only if the catheter remains unclamped with syringe removal. The is a Positive Displacement device, not a positive pressure device and its intent is to force fluid out of the end of the IV catheter upon syringe disconnection. After approx. 10 seconds, then it is fine and accepted practice to clamp the IV catheter or the extension set.

[Sun0408, ASN, RN]

We use power PICC's and none of them have clamps.. Now our TLC's have clamps and I do clamp those off it not in use..