Port's and PICC's:????

Some say flush with heplock, some say flush with saline...some say lay flat for 15 minutes...some say lay flat for 30 minutes...FOR D/Cing PICC Lines...

As far as ports at our hospital we flush with heplock then saline.

I will tell you what the minimum standard of care is to discontinue any CVC

1. Place pt in flat in bed if pt intubated or can not cooperate plan to d/c line on expiratory exhalation

2. Perform hand hygiene,explain procedure to pt and explain how to perform Valsalva maneuver (yes even on PICCs).

3.Don non-sterile gloves and loosen entire dressing,clip any sutures (do not use a scalpel to do this.

4. Have all supplies already open and ready to go...instuct pt to perform Valsalva..... and then pull out gather using a hand over hand technique (especially important when d/cing silicone PICCs so you do not snap them) in a steady motion using your dominant hand,with your non-dominant hand have a folded 4x4 or folded 2x2s ready near site...once catheter is out immediately apply gauze dressing and hold direct pressure until bleeding stops. Then apply an occlusive (sterile ung or a very small piece of Vaseline gauze) then dry gauze and secure in an occlusive manner with tape. The use of ung after d/cing CVCs is a fairly new recommendation and this is to eliminate the risk of air being sucked in through the hole and or tunnel the catheter has made. Although rare it can and does happen,especially when d/cing large catheters such as Hemodialysis/Apheresis catheters. Also this will soon be a never-event and if occurs the hospital will no longer be paid by medicare for any medical care needed post event.

4. Document procedure commenting on the fact that an intact catheter was d/ced.condition of site and any or no s/sx of catheter-related complications and any teaching you provided such as pt instructed to keep dressing over site at least 24 hours or until healed. One caution when d/cing a multi-lumen catheter with a multi-staggered tip.....pull this out a bit faster so that the pt can not suck in air as the proximal and medial lumens will be pulled out of the vein first and distal will still be in the vein and if this king ever gets stuck make sure you clamp it at the skin level to avoid a air embolism while you are waiting for help. Sometimes these can get stuck between the clavicle and the rib. As long as you have made an occlusive dressing properly it is sealed and air can not be sucked in....so no need to lie flat for 15 min...b/c that is the whole pupose of the thing. Sometimes if the pt bled a lot and I had to hold pressure a while I ask them to rest in brd for 15 min or so ...so the bleeding will not resume.

I will tell you what the minimum standard of care is to discontinue any CVC

1. Place pt in flat in bed if pt intubated or can not cooperate plan to d/c line on expiratory exhalation

2. Perform hand hygiene,explain procedure to pt and explain how to perform Valsalva mamneuver (yes even on PICCs).

3.Don non-sterile gloves and loosen entire dressing,clip any sutures (do not use a scalpel to do this.

4. Have all supplies already open and ready to go...instruct pt to perform Valsalva..... and then pull out gather using a hand over hand technique (especially important when d/cing silicone PICCs so you do not snap them) in a steady motion using your dominant hand,with your non-dominant hand have a folded 4x4 or folded 2x2s ready near site...once catheter is out immediately apply gauze dressing and hold direct pressure until bleeding stops. Then apply an occlusive (sterile ung or a very small piece of vaseline gauze) then dry gauze and secure in an occlusive manner with tape. The use of ung after d/cing CVCs is a fairly new recommendation and this is to eliminate the risk of air being sucked in through the hole and or tunnel the catheter has made. Although rare it can and does happen,especially when d/cing large catheters such as Hemodialysis/Apheresis catheters. Also this will soon be a never-event and if occurs the hospital will no longer be paid by medicare for any medical care needed post event.

4. Document procedure commenting on the fact that an intact catheter was d/ced.condition of site and any or no s/sx of catheter-related complications and any teaching you provided such aas pt instructed to keep dressing over site at least 24 hours or until healed. One caution when d/cing a multi-lumen catheter with a multi-staggered tip.....pull this out a bit faster so that the pt can not suck in air as the proximal and medial lumens will be pulled out of the vein first and distal will still be in the veinand if this king ever gets stuck make sure you clamp it at the skin level to avoid a air embolism while you are waiting for help. Sometimes these can get stuck between the clavicle and the rib.

As far as ports go the recommend flush amts and Heparin strengths vary 10 units per ml up to 1000 units per ml. The most common strengths used on Adult portsd is 100 units per ml. Each hospital anf health care organization has to establish flush protocols that meet reasonable and prudent standards. Here is a common flush protocol for ports 10 ml NS flush followed by 100 units per ml (1-5 ml) for intermittent infusions with double the NS after blood draws. For the monthly flush and after de-activation flush with 10 ml NS then 5 ml heparin (100 units per ml). I just the Heparin on our locked ports being used for intermittent infusion and post blood draw to 1 ml of Heparin (100 units per ml mixed with 4 ml NS) to decrease the heparin that can add up when using these locked lumens frequently. You need to have flush volumes of at least 2 x the priming volume of CVCs and ports average about 2.5 ml so 5 ml should be the absolute minimum in adults