PICCs

[75au78]

I have a question regarding PICCs (or central lines, in general). I have seen nurses flush all three lumens of a Triple-lumen PICC with a single 10ml prefill NS syringe and then a single heparin prefill syringe, and I have also seen nurses flush each lumen with it's own 10ml prefill syringe (3 individual NS syringes and then three individual heparin syringes). Our prefills include enough NS in 1 syringe to flush all 3 (we use 2ml NS each lumen), but I was taught to use a different syringe for each lumen. Which is the correct way, and why? I thought about the contamination issue, but if one lumen is contaminated, the whole line is bad anyway.

Thanks for any help anyone can provide.

[ERjodiRN]

i personally don't see anything wrong with using 1 syringe since you don't need to flush a full 10cc through each lumen. however, the CORRECT way....and by correct i mean the way it's probably written in every hospital's policy and procedure manual......is to use a syringe for each port, and yes...it's to prevent contamination. yes, if one port is bad the whole line is...but how does that one port get bad? they aren't concerned about using the same syringe you used on a contaminated port to the same line. they are concerned that the syringe itself becomes contaminated from one port to the next. maybe someone sneezes on it with their mrsa infected nostrils, who knows. but that is what they are concerned about.

[mama_d, BSN, RN]

Our hospital's policy is to pulse flush with 10 mL of NS in each port q8hr, and heparin is a no-no. Personally I would just use one syringe per port; no infection control research to back me up, but it just sounds like the right answer :)

[ChristineN, BSN, RN]

Our hospital's policy is to pulse flush with 10 mL of NS in each port q8hr, and heparin is a no-no. Personally I would just use one syringe per port; no infection control research to back me up, but it just sounds like the right answer :)

No Heparin for central lines?! I'm curious as to their reasoning. My facility doesn't allow Heparin in peripheral lines, but it's policy when you are disconnecting a pt from a central line to flush each lumen with 10cc of saline, and then 3cc of 10:1 concentration Heparin. I actually took care of a pt that got a PE from a blood clot that broke free from his PICC line and went to his lung, so I would be very nervous about not Heprinizing my central lines.

[ERjodiRN]

i agree w/ your take on the heparin flush. unless they are on some kind of fluid continuously, we flush the ports with heparin on all our central lines.

[SteffersRN87, BSN, RN]

we flush each port with 10 mL's and each port gets a different alcohol swab and syringe... after medications, we flush with 10 mL... after blood draws, we flush with 20 mL's... and we dont not use heparin anymore

[Aneroo, LPN]

I remember flushing each port with its own 10ml and then heparin per our policy.

One concern with that- if the patient is also fluid overloaded or is at risk for fluid overload, the frequent flushes with meds/S.A.S.H. can push them over the limit and into overload.

[Aneroo, LPN]

I wanted to add: I love threads like this one and the lantus one. These aren't things I do much (especially now that I'm a school nurse ), and I like reading everyones rationales and different hospitals/different policies.

[LittleWing21, RN]

I do 5-10cc NS in each lumen (aren't they typically 5ml? i think it says in small print on the tubing but I could be totally wrong!) then 1.5 ml of hep (1/2 syringe) in each. That's pretty much standard at our hospital..although technically the docs are supposed to write an order for it. PICCs are a major source of controversy on the floor and EVERYONE says something different....like changing the caps after blood draws. This is something that isn't written in the protocol, but something I tend to do anyways since a busted PICC is such a pain!!!!

[Virgo_RN, BSN, RN]

Our hospital policy is to flush with 10mL NS using the pulsatile method Q8 hours. We no longer use heparin. We did a test/study before adopting this policy, and the result was that central lines did not occlude any more frequently with the NS flushes than they did using heparin, and NS does not carry the risk of HIT that heparin does.

[FlyingScot, RN]

Our policy is 20ml flush after blood draw 10ml for just regular flushing. Also use the "Push-Pause" method. If the PICC has clamps on it then we presume it is open-ended and it gets Heparin. No clamps=no Heparin because it is closed-ended.

[lpnflorida]

Each lumen gets its own individual syringe of 10cc normal saline, blood draws change the caps then flush with 20cc normal saline . We use the pulsilate technique also. Lines are flushed every 8 hours and with each blood draw.