PICC with too much resistance

[tokebi]

I am an IV certified LVN and I often flush the line when IV anibiotics are done.

The other day, I was asked to flush a resident's PICC. I disconnected the tubing and proceeded to flush. To my dismay, it would not go! With much huffing and puffing, I managed to push in all the saline in the syringe. I was worried about it and meant to ask the RN but got distracted with something else...

How is it possible that the PICC line, where the medication was dripping just fine, has so much resistance when flushing? Or could it be that I was doing something incorrectly? Is it even safe to push that hard?

In case you're thinking it, of course I made sure that it was not clamped. :)

[DogCrazy]

Might have been getting sluggish, maybe has a fibrin cap on the end. I'm guessing the medicine went in at a slower rate than your flush. It probably just needs to be activased.

[Coffee Nurse, BSN, RN]

Or could be a positional thing -- if it's in the antecube and the patient's arm is bent sharply. (At least, this is a problem we sometimes have in the NICU; I don't know if adults get a sufficiently large-bore catheter that this isn't an issue for them.) At any rate, I probably wouldn't push that hard without troubleshooting first, just to be on the safe side.

[Zookeeper3]

consider having the patient turn their head in the opposite direction, aspirating or getting an order for activace. Each policy is different, but we are taught to assume there is a clot that has formed inside and don't force any flush out of fear of dislodging the "clot".

Great question though, doing cardiac outputs has been my only experience in forcing anything hard in nursing.

[babieface_7]

I agree with zookeeper. It is dangeorous to force the picc line. Ive heard of someone having a cva because of that and was sued. babieface_7

[Emergency RN]

I agree with zookeeper. It is dangeorous to force the picc line. Ive heard of someone having a cva because of that and was sued. babieface_7

Doubtful that a clot from a PICC (venous system) would cause a CVA; not unless there was a right to left shift through either an atrial or ventricular septal defect. A venous system embolus would usually stop in the lung as a pulmonary embolus.

But the sentiment is well taken. Applying high injection pressure (other than for the already mention cardiac output measurement) to any line is generally a bad idea. If the usual bedside maneuvers don't work (turn head to opposite side, abduct and externally rotate arm with PICC) then it likely needs to be declotted.

[ChristineN, BSN, RN]

I probably would have seen if you could aspirate blood back. If you can get blood, then it probably doesn't need to be TPA'ed, and in that case could be a positional problem.

[IVRUS, BSN, RN]

I am an IV certified LVN and I often flush the line when IV anibiotics are done.

The other day, I was asked to flush a resident's PICC. I disconnected the tubing and proceeded to flush. To my dismay, it would not go! With much huffing and puffing, I managed to push in all the saline in the syringe. I was worried about it and meant to ask the RN but got distracted with something else...

How is it possible that the PICC line, where the medication was dripping just fine, has so much resistance when flushing? Or could it be that I was doing something incorrectly? Is it even safe to push that hard?

In case you're thinking it, of course I made sure that it was not clamped. :)

If you had to "Huff and Puff" you were doing something that you shouldn't have been doing!

If you meet resistance when flushing with a 10cc syringe you:

1. Don't obtain a smaller syringe and try to flush again because the smaller syringes exert too much PSI's and can either dislodge a thrombus or cause the IV catheter to break or split.

2. Always want to flush a line, right after the IV antibiotic has completed to prevent reflux of blood into the line and subsequent occlusion.

3. Always make sure you are flushing with the appropriate solution. In many cases, that solution is Normal Saline. However, be aware that some IV medications are incompatable with Saline, and if you flush the IV catheter right after the antibiotic is complete with this solution a precipitate will form and this too leads to an occlusion. (btw, cathflo will not clear this type of occlusion).

Once any resistance is felt, STOP flushing attempts!! At that point, a RN in house, or one contracted with your pharmacy needs to obtain an order for cathflo and attempt to restore patency. (That is if it is a fibrin buildup or thrombus formation causing it.)

Hope this helps.

[tokebi]

Thank you so much for the feedback. I'll keep in mind the advices and be more careful in the future!