PICC

[emilysmom,RN]

Have a patient that went into hosp with pain from esophogeal CA and is on chemo and radiation. Sent home on a Sunday PM with a PICC. Told the hospital CM that would not be able to see until Monday,they said they would flush before patient was discharged. But the dc paperwork does not mention flush or dressing change orders. She only uses the PICC for blood draws and weekly chemo only. Is it alright for daily saline and Heparin flushes?

[RachRN66]

Your company should have a policy/procedure about how to manage PICCs in the home setting. For example, our company says to flush unused PICC lines with 5ml of 10:1 U heparin daily, PICC line dressings 'and end caps are changed weekly. IF the PICC is ONLY for the use of the OutPatient Chemo dept, and the agency is not using the PICC for labs/infusions then the OutPatient department needs to supply the patient with flushes and dressing kits, and they should be the ones to change the dressing if the patient is going in to the Out Patient department at least weekly. Then if that is the ONLY skill that you are seeing the patient for, she does not need home health, as it should be managed by the Out Patient department. That's our company's policy. If the MD ordered you to get labs from the PICC then you should be flushing with NS before/after the procedure and with Heparin daily, changing picc caps after blood draws and weekly picc line dressing changes. Supplies then would be coming from your agency/pharmacy etc. I hope this helps.

[IVRUS, BSN, RN]

Emily's mom,

As the above poster stated, You should have a policy in place on how to care for PICC's and other IV catheters. Saline and Heparin is NOT used for ALL catheters. Catheters that are less than 3 inches in length, or an open ended IV catheter over 3 inches in length get heparinized as the final flush (Always use the lowest concentration of Heparin Flush-usually 10units/ml unless your heparinzing an implanted port).

If the IV catheter is a closed ended, or is a valved IV catheter (Groshong, PASV, SOLO power PICC) then it is to be flushed with saline only. The Heparin isn't needed for these IV catheters. If you can avoid using Heparin Flush, avoid it. Though, one worries about HIT when using Heparin Flush, it really is the only approved "locking agent" on the market in the US.

Valved IV catheters like those mentioned, usually only need flushing weekly if you're doing maintenance. Non-valved catheter's are either q 12 or q 24. And, drsg changes in most P&P (Homecare) are done weekly, with weekly injection cap changes.

Hope your policy directs you appropriately.