Policy/Practice with capped PICC

[RN4Little1s]

Your baby's PICC is capped and clamped.

1) What is routine care (flushes) if you are not giving anything through it?

2) How do you flush with frequent intermittent meds? NS? Hep NS?

We have scheduled hep NS flushes TID. Then when there are intermittent meds between and with those, people flush differently.

[ilstu99]

We don't use heparin in our unit. All lines not in use are flushed Q6.

I think there's a thread very similar to this one a little farther down the page.

[elizabells, BSN, RN]

We don't cap or clamp PICCs at all, ever.

[RN4Little1s]

elizabells, what is the reasoning for that? say they are up to full feeds but still need intermittent antibiotics/meds, what do you keep running through it?

[elizabells, BSN, RN]

To prevent clotting, I suppose. We switch all meds that can to PO to oral forms. If there's one that can't, (like Gent for a ROS) we'll run D5 1:1 hep at 1.2ml. That's usually only for a day or so. I don't see many kids with long-term IV only meds who are on full feeds. We try to get our PICCs out as soon as humanly possible, so we may even go to a saline lock PIV at that point if it's going to be a while. Very rarely (I've seen in once in 2+ years) they'll put in a Portacath if there's an intermittent thing - bisphosphonate for an osteogenesis imperfecta kid, the time I saw it.

[texas2007, BSN, RN]

When a baby is advanced to full feeds, we generally keep the picc line hep-flushed q 12. If the patient tolerated it well, they will usually pull the line the next day.

[Sweeper933]

We pretty much do the same thing as Elizabells. We never cap our PICC lines. Once they're up to full feeds, but we still need the line for antibiotics we just keep D10Lytes w/ 1unit of heparin/ml going to keep the line open.

[dawngloves, BSN, RN]

We also KVO our PICCs for kids that need them only for abx. D10 w/ heparin @ 1ml/hr.

[UTVOL3]

We don't cap or clamp PICCs at all, ever.

We don't either. Run something with 1/2 unit heparin/cc at 1 ml/hr on the tiny ones, maybe 3ml/hr on the big kids. They just clot too fast and I think it is considered a bit of an infection risk too.

[TiffyRN, BSN, PhD]

The unit where I work, the protocol is flush 0.5 to 1ml every 6hrs of NS + heparin 2units/ml. I actually am not sure the dilutent anymore, we recently changed to these premixed syringes and I think it's NS but I'm not sure.

Those HL'd PICC's do tend to clot off pretty frequently. I could see not keeping one. It just seems the minute we take one out, the kit will need it for something.

[NICU_babyRN, BSN, RN]

PICC: Hep flush with 0.5ml Hep NS (5units of heparin) q4hrs.

CVL: Hep flush with 1ml Hep NS (10 units heparin) q6hrs.

[lvnurs9]

We also never cap PICCs. We run TKO 1/2NS+1/2unit heparin/ml at 1ml/hr.