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!

[raskol]

Thanks guys you have been so helpful

[StarrAndrewsStrong]

Hello I am not sure if this question has been answered or not but I really like to hear from other nurses and I am getting conflicting answers. I have a patient that has a power picc 4Fr dual lumen Solo. She was told by different nurses to use the red caps at the end of the tubing in order to protect bacteria from getting inside. I have seen the green caps and there are red one also she was told to cap it and not clamp. I know these are made if you cap it doesn't it de pressure it and can actually cause more harm? The last one was pulled and she cap them with the red caps you would use on your IV tubing after you prime it.

I like to hear from others, I just finish nursing school and are new to Picc lines. also each picc line she has she has broken out in weeping blisters, we are currently using mexplex border on it to cover it and using the no sting skin prep and Optsite to go over it as it doesn't stay on the full 7 days, we use a cathguard to hold each of her tubing in to protect it . Is there anything else we can do to prevent the blistering when it gets bad? The tubing exten has a Clamp but the hospital said take it off.

If anyone could help me out I would appreacite it

Starr Andrews Strong

[Wuzzie]

I'm confused, are you talking about swab caps when you mention red and green caps? Or the intermittent access cap (for lack of a better term)?

She's likely blistering because people aren't letting the CHG or the skin prep dry completely before placing the dressing. This has been known to cause chemical burns. Or they are stretching the Tegaderm when they apply it which causes skin shearing. A very few, and I mean very few people are allergic to the actual adhesive on the Tegaderm. They have a sensitive skin version that you could try but what you are describing seems more like user error.

Not sure Mepilex is the best choice but if used should not be left on for 7 days. It is essentially a gauze dressing and needs to be changed every 48-72 hours. You'd probably do just as well with regular sterile gauze and a roller bandage with steri-strips to secure the line itself.

The rest of your questions are not quite clear.

[brillohead, ADN, RN]

I had a patient who got blisters from the adhesive on the Statlock that the "wings" of the PICC snap into. His dressing changes were weekly, and I moved the Statlock each time, because the skin underneath was just raw. This was in a home health environment, not a facility.

I told him that if he ever needs a PICC again, he needs to have it sutured in place versus using the Statlock. His skin reacts to a lot of different adhesives, and the only "safe" adhesives I've found for him are Tegaderm and foam tape.

I'm curious if your patient's skin is blistering due to the PICC line itself, or the "cathguard" and other adhesives you're using on it.