PICC TKO Rate

[NicuCourtney]

I was wondering if anyone had policies regarding the TKO rate for PICC's once the baby is currently on full feeds. We have a couple different methods and I am hoping to standardize the way we keep these tiny lines open including:

- 1 ml/hr on buretrol pump (with bag of fluid)

- 2 ml/hr on buretrol pump

- 1 ml/hr on syringe pump

Our theory is that with the consistent pressure on the syringe pump, the rate can be decreased. I have yet to see a PICC clot off with any of these methods, but am wondering what other NICUs are doing!

Thanks

Courtney

[labordude, BSN, RN]

Having worked in a couple of different NICUs, I have seen it done differently.

Currently we leave them running 1ml/hr on a syringe pump with 1 unit of Heparin per ml. The PICCs are 1.9fr, mostly single lumens. In the past at other places, I have run 0.5ml/hr with 0.5-1 unit of heparin per ml (into a 1.9fr double lumen PICC). The first place I ever worked did not run continuous fluids and flushed q8h with 2ml of NS containing 2 units of heparin per ml (into 2fr PICCs). I have had more PICCs clot off using the continuous method as compared to the q8 flushes.

Sorry for more confusion!

[SteveNNP, MSN, NP]

We use only 1 and 2fr single lumen catheters here. As soon as a a baby is on full feeds, that line comes the heck out. We rarely use PICCs just for meds, and usually only when a baby is on long-term endocarditis tx.

[NeoNurseTX, RN]

We do q12 hep flushes..but if the baby is on full feeds and doesn't need the PICC for anything, we pull it.

[NICU_babyRN, BSN, RN]

q4hr hep flush of 0.5 ml NS with a total of 5 units heparin to each port.

[littleneoRN]

Clear fluids with 1 unit heparin/1 mL. Running at 1 ml/hour from a bag via a pump without buretrol. We mainly use 1.9 fr single lumen. Typically, we only keep the PICC in for about 24 hours after reaching full feeds to ensure the baby is tolerating the full feeds. We will keep it in for long-term antibiotic access. I have only ever seen one clot off with this method, but I still consider myself a relative newbie.

[nurserynurse55]

We use continuous running of 2cc an hour (no heparin) or 1cc an hour with heparin. I have seen many clot off too.

[jlb_rn]

Minimum that I've seen in our unit is 0.5ml/hr continuous infusion with heparin & 0.45NS 1:1. 1ml/hr is what I see most often, though, with the aforementioned solution.

As another poster stated, we also pull PICCs ASAP once they are no longer needed. Usually, the only time I see riders is when we have a double lumen and we don't really have need for that second lumen anymore, but can't quite pull the PICC yet or for that 24-48ish hour period when we are making sure the line is no longer needed.

We also very rarely use a PICC for meds alone - we would use a PIV in that instance.

[BittyBabyGrower, MSN, RN]

We run a 1:1 1/2 NS heparin gtt thru on a pump at 0.5ml/hr. We use Piccs for

ABX treatment greater than 7 days. Once the treatment is done, the picc is pulled. We will occas cap them on the chronic kids in case they get sick.